Anomalies and Curiosities of Medicine
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Title: Anomalies and Curiosities of Medicine
Author: George M. Gould
Walter L. Pyle
Release date: December 1, 1996 [eBook #747]
Most recently updated: January 1, 2021
Language: English
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Credits: Produced by Charles Keller. HTML version by Al Haines.
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Produced by Charles Keller. HTML version by Al Haines.
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.
CHAPTER II.
PRENATAL ANOMALIES.
Extrauterine Pregnancy.--In the consideration of prenatal anomalies,
the first to be discussed will be those of extrauterine pregnancy. This
abnormalism has been known almost as long as there has been any real
knowledge of obstetrics. In the writings of Albucasis, during the
eleventh century, extrauterine pregnancy is discussed, and later the
works of N. Polinus and Cordseus, about the sixteenth century, speak of
it; in the case of Cordseus the fetus was converted into a lithopedion
and carried in the abdomen twenty-eight years. Horstius in the
sixteenth century relates the history of a woman who conceived for the
third time in March, 1547, and in 1563 the remains of the fetus were
still in the abdomen.
Israel Spach, in an extensive gynecologic work published in 1557,
figures a lithopedion drawn in situ in the case of a woman with her
belly laid open. He dedicated to this calcified fetus, which he
regarded as a reversion, the following curious epigram, in allusion to
the classical myth that after the flood the world was repopulated by
the two survivors, Deucalion and Pyrrha, who walked over the earth and
cast stones behind them, which, on striking the ground, became people.
Roughly translated from the Latin, this epigram read as follows:
"Deucalion cast stones behind him and thus fashioned our tender race
from the hard marble. How comes it that nowadays, by a reversal of
things, the tender body of a little babe has limbs nearer akin to
stone?" Many of the older writers mention this form of fetation as a
curiosity, but offer no explanation as to its cause. Mauriceau and de
Graaf discuss in full extrauterine pregnancy, and Salmuth, Hannseus,
and Bartholinus describe it. From the beginning of the eighteenth
century this subject always demanded the attention and interest of
medical observers. In more modern times, Campbell and
Geoffroy-Saint-Hilaire, who named it "Grossesse Pathologique," have
carefully defined and classified the forms, and to-day every text-book
on obstetrics gives a scientific discussion and classification of the
different forms of extrauterine pregnancy.
The site of the conception is generally the wall of the uterus, the
Fallopian tube, or the ovary, although there are instances of pregnancy
in the vagina, as for example when there is scirrhus of the uterus; and
again, cases supposed to be only extrauterine have been instances
simply of double uterus, with single or concurrent pregnancy. Ross
speaks of a woman of thirty-three who had been married fourteen years,
had borne six children, and who on July 16, 1870, miscarried with twins
of about five months' development. After a week she declared that she
was still pregnant with another child, but as the physician had placed
his hand in the uterine cavity after the abortion, he knew the fetus
must be elsewhere or that no pregnancy existed. We can readily see how
this condition might lead to a diagnosis of extrauterine pregnancy, but
as the patient insisted on a thorough examination, the doctor found by
the stethoscope the presence of a beating fetal heart, and by vaginal
examination a double uterus. On introducing a sound into the new
aperture he discovered that it opened into another cavity; but as the
woman was pregnant in this, he proceeded no further. On October 31st
she was delivered of a female child of full growth. She had menstruated
from this bipartite uterus three times during the period between the
miscarriage of the twins and the birth of the child. Both the mother
and child did well.
In most cases there is rupture of the fetal sac into the abdominal
cavity or the uterus, and the fetus is ejected into this location, from
thence to be removed or carried therein many years; but there are
instances in which the conception has been found in situ, as depicted
in Figure 2. A sturdy woman of thirty was executed on January 16, 1735,
for the murder of her child. It was ascertained that she had passed her
catamenia about the first of the month, and thereafter had sexual
intercourse with one of her fellow-prisoners. On dissection both
Fallopian tubes were found distended, and the left ovary, which bore
signs of conception, was twice as large as the right. Campbell quotes
another such case in a woman of thirty-eight who for twenty years had
practised her vocation as a Cyprian, and who unexpectedly conceived. At
the third month of pregnancy a hard extrauterine tumor was found, which
was gradually increasing in size and extending to the left side of the
hypogastrium, the associate symptoms of pregnancy, sense of pressure,
pain, tormina, and dysuria, being unusually severe. There was
subsequently at attack of inflammatory fever, followed by tumefaction
of the abdomen, convulsions, and death on the ninth day. The fetus had
been contained in the peritoneal coat of the ovary until the fourth
month, when one of the feet passed through the cyst and caused the
fatal result. Signs of acute peritonitis were seen postmortem, the
abdominal cavity was full of blood, and the ovary much lacerated.
The termination of extrauterine pregnancy varies; in some cases the
fetus is extracted by operation after rupture; in others the fetus has
been delivered alive by abdominal section; it may be partially
absorbed, or carried many years in the abdomen; or it may ulcerate
through the confining walls, enter the bowels or bladder, and the
remnants of the fetal body be discharged.
The curious cases mentioned by older writers, and called abortion by
the mouth, etc., are doubtless, in many instances, remnants of
extrauterine pregnancies or dermoid cysts. Maroldus speaks in full of
such cases; Bartholinus, Salmuth, and a Reyes speak of women vomiting
remnants of fetuses. In Germany, in the seventeenth century, there
lived a woman who on three different occasions is said to have vomited
a fetus. The last miscarriage in this manner was of eight months'
growth and was accompanied by its placenta. The older observers thought
this woman must have had two orifices to her womb, one of which had
some connection with the stomach, as they had records of the dissection
of a female in whom was found a conformation similar to this.
Discharge of the fetal bones or even the whole of an extrauterine fetus
by the rectum is not uncommon. There are two early cases mentioned in
which the bones of a fetus were discharged at stool, causing intense
pain. Armstrong describes an anomalous case of pregnancy in a
syphilitic patient who discharged fetal bones by the rectum. Bubendorf
reports the spontaneous elimination of a fetal skeleton by the rectum
after five years of retention, with recovery of the patient. Butcher
speaks of delivery through the rectum at the fourth month, with
recovery. Depaul mentions a similar expulsion after a pregnancy of
about two months and a half. Jackson reports the dissection of an
extrauterine sac which communicated freely with the large intestine.
Peck has an example of spontaneous delivery of an extrauterine fetus by
the rectum, with recovery of the mother. Skippon, in the early part of
the last century, reports the discharge of the bones of a fetus through
an "imposthume" in the groin. Other cases of anal discharge of the
product of extrauterine conception are recorded by Winthrop, Woodbury,
Tuttle, Atkinson, Browne, Weinlechner, Gibson, Littre, Magruder,
Gilland, and many others. De Brun du Bois-Noir speaks of the expulsion
of extrauterine remains by the anus after seven years, and Heyerdahl
after thirteen years. Benham mentions the discharge of a fetus by the
rectum; there was a stricture of the rectum associated with syphilitic
patches, necessitating the performance of colotomy.
Bartholinus and Rosseus speak of fetal bones being discharged from the
urinary passages. Ebersbach, in the Ephemerides of 1717, describes a
necropsy in which a human fetus was found contained in the bladder. In
1878 White reported an instance of the discharge of fetal remains
through the bladder.
Discharge of the Fetus through the Abdominal Walls.--Margaret Parry of
Berkshire in 1668 voided the bones of a fetus through the flesh above
the os pubis, and in 1684 she was alive and well, having had healthy
children afterward. Brodie reports the history of a case in a negress
who voided a fetus from an abscess at the navel about the seventeenth
month of conception. Modern instances of the discharge of the
extrauterine fetus from the walls of the abdomen are frequently
reported. Algora speaks of an abdominal pregnancy in which there was
spontaneous perforation of the anterior abdominal parietes, followed by
death. Bouzal cites an extraordinary case of ectopic gestation in which
there was natural expulsion of the fetus through abdominal walls, with
subsequent intestinal strangulation. An artificial anus was established
and the mother recovered. Brodie, Dunglison, Erich, Rodbard, Fox, and
Wilson are among others reporting the expulsion of remnants of ectopic
pregnancies through the abdominal parietes. Campbell quotes the case of
a Polish woman, aged thirty-five, the mother of nine children, most of
whom were stillborn, who conceived for the tenth time, the gestation
being normal up to the lying-in period. She had pains followed by
extraordinary effusion and some blood into the vagina. After various
protracted complaints the abdominal tumor became painful and inflamed
in the umbilical region. A breach in the walls soon formed, giving exit
to purulent matter and all the bones of a fetus. During this process
the patient received no medical treatment, and frequently no assistance
in dressing the opening. She recovered, but had an artificial anus all
her life. Sarah McKinna was married at sixteen and menstruated for the
first time a month thereafter. Ten months after marriage she showed
signs of pregnancy and was delivered at full term of a living child;
the second child was born ten months after the first, and the second
month after the second birth she again showed signs of pregnancy. At
the close of nine months these symptoms, with the exception of the
suppression of menses, subsided, and in this state she continued for
six years. During the first four years she felt discomfort in the
region of the umbilicus. About the seventh year she suffered
tumefaction of the abdomen and thought she had conceived again. The
abscess burst and an elbow of the fetus protruded from the wound. A
butcher enlarged the wound and, fixing his finger under the jaw of the
fetus, extracted the head. On looking into the abdomen he perceived a
black object, whereupon he introduced his hand and extracted piecemeal
an entire fetal skeleton and some decomposed animal-matter. The abdomen
was bound up, and in six weeks the woman was enabled to superintend her
domestic affairs; excepting a ventral hernia she had no bad
after-results. Kimura, quoted by Whitney, speaks of a case of
extrauterine pregnancy in a Japanese woman of forty-one similar to the
foregoing, in which an arm protruded through the abdominal wall above
the umbilicus and the remains of a fetus were removed through the
aperture. The accompanying illustration shows the appearance of the arm
in situ before extraction of the fetus and the location of the wound.
Bodinier and Lusk report instances of the delivery of an extrauterine
fetus by the vagina; and Mathieson relates the history of the delivery
of a living ectopic child by the vagina, with recovery of the mother.
Gordon speaks of a curious case in a negress, six months pregnant, in
which an extrauterine fetus passed down from the posterior culdesac and
occluded the uterus. It was removed through the vagina, and two days
later labor-pains set in, and in two hours she was delivered of a
uterine child. The placenta was left behind and drainage established
through the vagina, and the woman made complete recovery.
Combined Intrauterine and Extrauterine Gestation.--Many
well-authenticated cases of combined pregnancy, in which one of the
products of conception was intrauterine and the other of extrauterine
gestation, have been recorded. Clark and Ramsbotham report instances of
double conception, one fetus being born alive in the ordinary manner
and the other located extrauterine. Chasser speaks of a case in which
there was concurrent pregnancy in both the uterus and the Fallopian
tube. Smith cites an instance of a woman of twenty-three who became
pregnant in August, 1870. In the following December she passed fetal
bones from the rectum, and a month later gave birth to an intrauterine
fetus of six months' growth. McGee mentions the case of a woman of
twenty-eight who became pregnant in July, 1872, and on October 20th and
21st passed several fetal bones by the rectum, and about four months
later expelled some from the uterus. From this time she rapidly
recovered her strength and health. Devergie quotes an instance of a
woman of thirty who had several children, but who died suddenly, and
being pregnant was opened. In the right iliac fossa was found a male
child weighing 5 pounds and 5 ounces, 8 1/2 inches long, and of about
five months' growth. The uterus also contained a male fetus of about
three months' gestation. Figure 4 shows combined intrauterine and
extrauterine gestation. Hodgen speaks of a woman of twenty-seven, who
was regular until November, 1872; early in January, 1873, she had an
attack of pain with peritonitis, shortly after which what was
apparently an extrauterine pregnancy gradually diminished. On August
17, 1873, after a labor of eight hours, she gave birth to a healthy
fetus. The hand in the uterus detected a tumor to the left, which wag
reduced to about one-fourth the former size. In April, 1874, the woman
still suffered pain and tenderness in the tumor. Hodgen believed this
to have been originally a tubal pregnancy, which burst, causing much
hemorrhage and the death of the fetus, together with a limited
peritonitis. Beach has seen a twin compound pregnancy in which after
connection there was a miscarriage in six weeks, and four years after
delivery of an extrauterine fetus through the abdominal walls. Cooke
cites an example of intrauterine and extrauterine pregnancy progressing
simultaneously to full period of gestation, with resultant death.
Rosset reports the case of a woman of twenty-seven, who menstruated
last in November, 1878, and on August 5, 1879, was delivered of a
well-developed dead female child weighing seven pounds. The uterine
contractions were feeble, and the attached placenta was removed only
with difficulty; there was considerable hemorrhage. The hemorrhage
continued to occur at intervals of two weeks, and an extrauterine tumor
remained. Two weeks later septicemia supervened and life was despaired
of. On the 15th of October a portion of a fetus of five months' growth
in an advanced stage of decomposition protruded from the vulva. After
the escape of this putrid mass her health returned, and in four months
she was again robust and healthy. Whinery speaks of a young woman who
at the time of her second child-birth observed a tumor in the abdomen
on her right side and felt motion in it. In about a month she was with
severe pain which continued a week and then ceased. Health soon
improved, and the woman afterward gave birth to a third child;
subsequently she noticed that the tumor had enlarged since the first
birth, and she had a recurrence of pain and a slight hemorrhage every
three weeks, and distinctly felt motion in the tumor. This continued
for eighteen months, when, after a most violent attack of pain, all
movement ceased, and, as she expressed it, she knew the moment the
child died. The tumor lost its natural consistence and felt flabby and
dead. An incision was made through the linea alba, and the knife came
in contact with a hard, gritty substance, three or four lines thick.
The escape of several quarts of dark brown fluid followed the incision,
and the operation had to be discontinued on account of the ensuing
syncope. About six weeks afterward a bone presented at the orifice,
which the woman extracted, and this was soon followed by a mass of
bones, hair, and putrid matter. The discharge was small, and gradually
grew less in quantity and offensiveness, soon ceasing altogether, and
the wound closed. By December health was good and the menses had
returned.
Ahlfeld, Ambrosioni, Galabin, Packard, Thiernesse, Maxson, de
Belamizaran, Dibot, and Chabert are among others recording the
phenomenon of coexisting extrauterine and intrauterine pregnancy.
Argles mentions simultaneous extrauterine fetation and superfetation.
Sanger mentions a triple ectopic gestation, in which there was twin
pregnancy in the wall of the uterus and a third ovum at the fimbriated
end of the right tube. Careful examination showed this to be a case of
intramural twin pregnancy at the point of entrance of the tube and the
uterus, while at the abdominal end of the same tube there was another
ovum,--the whole being an example of triple unilateral ectopic
gestation.
The instances of delivery of an extrauterine fetus, with viability of
the child, from the abdomen of the mother would attract attention from
their rarity alone, but when coupled with associations of additional
interest they surely deserve a place in a work of this nature. Osiander
speaks of an abdominal fetus being taken out alive, and there is a
similar case on record in the early part of this century. The London
Medical and Physical Journal, in one of its early numbers, contained an
account of an abdominal fetus penetrating the walls of the bladder and
being extracted from the walls of the hypogastrium; but Sennertus gives
a case which far eclipses this, both mother and fetus surviving. He
says that in this case the woman, while pregnant, received a blow on
the lower part of her body, in consequence of which a small tumor
appeared shortly after the accident. It so happened in this case that
the peritoneum was extremely dilatable, and the uterus, with the child
inside, made its way into the peritoneal sac. In his presence an
incision was made and the fetus taken out alive. Jessop gives an
example of extrauterine gestation in a woman of twenty-six, who had
previously had normal delivery. In this case an incision was made and a
fetus of about eight months' growth was found lying loose in the
abdominal cavity in the midst of the intestines. Both the mother and
child were saved. This is a very rare result. Campbell, in his
celebrated monograph, in a total of 51 operations had only seen
recorded the accounts of two children saved, and one of these was too
marvelous to believe. Lawson Tait reports a case in which he saved the
child, but lost the mother on the fourth day. Parvin describes a case
in which death occurred on the third day. Browne quotes Parry as saying
that there is one twin pregnancy in 23 extrauterine conceptions. He
gives 24 cases of twin conception, one of which was uterine, the other
extrauterine, and says that of 7 in the third month, with no operation,
the mother died in 5. Of 6 cases of from four and a half to seven
months' duration, 2 lived, and in 1 case at the fifth month there was
an intrauterine fetus delivered which lived. Of 11 such cases at nine
months, 6 mothers lived and 6 intrauterine fetuses lived. In 6 of these
cases no operation was performed. In one case the mother died, but both
the uterine and the extrauterine conceptions lived. In another the
mother and intrauterine fetus died, and the extrauterine fetus lived.
Wilson a gives an instance of a woman delivered of a healthy female
child at eight months which lived. The after-birth came away without
assistance, but the woman still presented every appearance of having
another child within her, although examination by the vagina revealed
none. Wilson called Chatard in consultation, and from the fetal
heart-sounds and other symptoms they decided that there was another
pregnancy wholly extrauterine. They allowed the case to go twenty-three
days, until pains similar to those of labor occurred, and then decided
on celiotomy. The operation was almost bloodless, and a living child
weighing eight pounds was extracted. Unfortunately, the mother
succumbed after ninety hours, and in a month the intrauterine child
died from inanition, but the child of extrauterine gestation thrived.
Sales gives the case of a negress of twenty-two, who said that she had
been "tricked by a negro," and had a large snake in the abdomen, and
could distinctly feel its movements. She stoutly denied any
intercourse. It was decided to open the abdominal cyst; the incision
was followed by a gush of blood and a placenta came into view, which
was extracted with a living child. To the astonishment of the operators
the uterus was distended, and it was decided to open it, when another
living child was seen and extracted. The cyst and the uterus were
cleansed of all clots and the wound closed. The mother died of
septicemia, but the children both lived and were doing well six weeks
after the operation. A curious case was seen in 1814 of a woman who at
her fifth gestation suffered abdominal uneasiness at the third month,
and this became intolerable at the ninth month. The head of the fetus
could be felt through the abdomen; an incision was made through the
parietes; a fully developed female child was delivered, but,
unfortunately, the mother died of septic infection.
The British Medical Journal quotes: "Pinard (Bull. de l'Acad. de Med.,
August 6, 1895) records the following, which he describes as an ideal
case. The patient was aged thirty-six, had had no illness, and had been
regular from the age of fourteen till July, 1894. During August of that
year she had nausea and vomiting; on the 22d and 23d she lost a fluid,
which was just pink. The symptoms continued during September, on the
22d and 23d of which month there was a similar loss. In October she was
kept in bed for two days by abdominal pain, which reappeared in
November, and was then associated with pain in micturition and
defecation. From that time till February 26, 1895, when she came under
Pinard's care, she was attended by several doctors, each of whom
adopted a different diagnosis and treatment. One of them, thinking she
had a fibroid, made her take in all about an ounce of savin powder,
which did not, however, produce any ill effect. When admitted she
looked ill and pinched. The left thigh and leg were painful and
edematous. The abdomen looked like that of the sixth month of
pregnancy. The abdominal wall was tense, smooth, and without lineae
albicantes. Palpation revealed a cystic immobile tumor, extending 2
inches above the umbilicus and apparently fixed by deep adhesions. The
fetal parts could only be made out with difficulty by deep palpation,
but the heart-sounds were easily heard to the right of and below the
umbilicus. By the right side of this tumor one could feel a small one,
the size of a Tangerine orange, which hardened and softened under
examination. When contracted the groove between it and the large tumor
became evident. Vaginal examination showed that the cervix, which was
slightly deflected forward and to the right and softened, as in uterine
gestation, was continuous with the smaller tumor. Cephalic
ballottement was obtained in the large tumor. No sound was passed into
the uterus for fear of setting up reflex action; the diagnosis of
extrauterine gestation at about six and a half months with a living
child was established without requiring to be clinched by proving the
uterus empty. The patient was kept absolutely at rest in bed and the
edema of the left leg cured by position. On April 30th the fundus of
the tumor was 35 cm. above the symphysis and the uterus 11 1/2 cm.; the
cervix was soft as that of a primipara at term. Operation, May 2d:
Uterus found empty, cavity 14 1/2 cm. long. Median incision in
abdominal wall; cyst walls exposed; seen to be very slight and filled
with enormous vessels, some greater than the little finger. On seizing
the wall one of these vessels burst, and the hemorrhage was only
rendered greater on attempting to secure it, so great was the
friability of the walls. The cyst was therefore rapidly opened and the
child extracted by the foot. Hemorrhage was restrained first by
pressure of the hands, then by pressure-forceps and ligatures. The
walls of the cyst were sewn to the margins of the abdominal wound, the
edge of the placenta being included in the suture. A wound was thus
formed 10 cm. in diameter, with the placenta for its base; it was
filled with iodoform and salicylic gauze. The operation lasted an hour,
and the child, a boy weighing 5 1/2 pounds, after a brief period of
respiratory difficulties, was perfectly vigorous. There was at first a
slight facial asymmetry and a depression on the left upper jaw caused
by the point of the left shoulder, against which it had been pressed in
the cyst; these soon disappeared, and on the nineteenth day the boy
weighed 12 pounds. The maternal wound was not dressed till May 13th,
when it was washed with biniodid, 1:4000. The placenta came away
piecemeal between May 25th and June 2d. The wound healed up, and the
patient got up on the forty-third day, having suckled her infant from
the first day after its birth."
Quite recently Werder has investigated the question of the ultimate
fate of ectopic children delivered alive. He has been able to obtain
the record of 40 cases. Of these, 18 died within a week after birth; 5
within a month; 1 died at six months of bronchopneumonia; 1 at seven
months of diarrhea; 2 at eleven months, 1 from croup; 1 at eighteen
months from cholera infantum--making a total of 26 deaths and leaving
14 children to be accounted for. Of these, 5 were reported as living
and well after operation, with no subsequent report; 1 was strong and
healthy after three weeks, but there has been no report since; 1 was
well at six months, then was lost sight of; 1 was well at the Last
report; 2 live and are well at one year; 2 are living and well at two
years; 1 (Beisone's case) is well at seven years; and 1 (Tait's case)
is well at fourteen and one-half years. The list given on pages 60 and
61 has been quoted by Hirst and Dorland. It contains data relative to
17 cases in which abdominal section has been successfully performed for
advanced ectopic gestation with living children.
Long Retention of Extrauterine Pregnancy.--The time of the retention of
an extrauterine gestation is sometimes remarkable, and it is no
uncommon occurrence for several pregnancies to successfully ensue
during such retention. The Ephemerides contains examples of
extrauterine pregnancy remaining in the abdomen forty-six years;
Hannaeus mentioned an instance remaining ten years, the mother being
pregnant in the meantime; Primperosius speaks of a similar instance; de
Blegny, one of twenty-five years in the abdomen; Birch, a case of
eighteen years in the abdomen, the woman bearing in the meantime;
Bayle, one of twenty-six years, and the Ephemerides, another. In a
woman of forty-six, the labor pains intervened without expulsion of the
fetus. Impregnation ensued twice afterward, each followed by the birth
of a living child. The woman lived to be ninety-four, and was persuaded
that the fetus was still in the abdomen, and directed a postmortem
examination to be made after her decease, which was done, and a large
cyst containing an ossified fetus was discovered in the left side of
the cavity. In 1716 a woman of Joigny when thirty years old, having
been married four years, became pregnant, and three months later felt
movements and found milk in her breasts. At the ninth month she had
labor-pains, but the fetus failed to present; the pains ceased, but
recurred in a month, still with a negative result. She fell into a most
sickly condition and remained so for eighteen months, when the pains
returned again, but soon ceased. Menstruation ceased and the milk in
her breasts remained for thirty years. She died at sixty-one of
peripneumonia, and on postmortem examination a tumor was found
occupying part of the hypogastric and umbilical regions. It weighed
eight pounds and consisted of a male fetus of full term with six teeth;
it had no odor and its sac contained no liquid. The bones seemed
better developed than ordinarily; the skin was thick, callous, and
yellowish The chorion, amnion, and placenta were ossified and the cord
dried up. Walther mentions the case of an infant which remained almost
petrified in the belly of its mother for twenty-three years. No trace
of the placenta, cord, or enveloping membrane could be found.
Cordier publishes a paper on ectopic gestation, with particular
reference to tubal pregnancy, and mentions that when there is rupture
between the broad ligaments hemorrhage is greatly limited by the
resistance of the surrounding structures, death rarely resulting from
the primary rupture in this location. Cordier gives an instance in
which he successfully removed a full-grown child, the result of an
ectopic gestation which had ruptured intraligamentally and had been
retained nearly two years.
Lospichlerus gives an account of a mother carrying twins, extrauterine,
for six years. Mounsey of Riga, physician to the army of the Czarina,
sent to the Royal Society in 1748 the bones of a fetus that had been
extracted from one of the fallopian tubes after a lodgment of thirteen
years. Starkey Middleton read the report of a case of a child which had
been taken out of the abdomen, having lain there nearly sixteen years,
during which time the mother had borne four children. It was argued at
this time that boys were conceived on the right side and girls on the
left, and in commenting on this Middleton remarks that in this case the
woman had three boys and one girl after the right fallopian tube had
lost its function. Chester cites the instance of a fetus being retained
fifty-two years, the mother not dying until her eightieth year.
Margaret Mathew carried a child weighing eight pounds in her abdomen
for twenty-six years, and which after death was extracted. Aubrey
speaks of a woman aged seventy years unconsciously carrying an
extrauterine fetus for many years, which was only discovered
postmortem. She had ceased to menstruate at forty and had borne a child
at twenty-seven. Watkins speaks of a fetus being retained forty-three
years; James, others for twenty-five, thirty, forty-six, and fifty
years; Murfee, fifty-five years; Cunningham, forty years; Johnson,
forty-four years; Josephi, fifteen years (in the urinary bladder);
Craddock, twenty-two years, and da Costa Simoes, twenty-six years.
Long Retention of Uterine Pregnancy.--Cases of long retained
intrauterine pregnancies are on record and deserve as much
consideration as those that were extrauterine. Albosius speaks of a
mother carrying a child in an ossified condition in the uterus for
twenty-eight years. Cheselden speaks of a case in which a child was
carried many years in the uterus, being converted into a clay-like
substance, but preserving form and outline. Caldwell mentions the case
of a woman who carried an ossified fetus in her uterus for sixty years.
Camerer describes the retention of a fetus in the uterus for forty-six
years; Stengel, one for ten years, and Storer and Buzzell, for
twenty-two months. Hannaeus, in 1686, issued a paper on such a case
under the title, "Mater, Infantis Mortui Vivum Sepulchrum," which may
be found in French translation.
Buchner speaks of a fetus being retained in the uterus for six years,
and Horstius relates a similar case. Schmidt's Jahrbucher contain the
report of a woman of forty-nine, who had borne two children. While
threshing corn she felt violent pain like that of labor, and after an
illness suffered a constant fetid discharge from the vagina for eleven
years, fetal bones being discharged with occasional pain. This poor
creature worked along for eleven years, at the end of which time she
was forced to bed, and died of symptoms of purulent peritonitis. At the
necropsy the uterus was found adherent to the anterior wall of the
abdomen and containing remnants of a putrid fetus with its numerous
bones. There is an instance recorded of the death of a fetus occurring
near term, its retention and subsequent discharge being through a
spontaneous opening in the abdominal wall one or two months after.
Meigs cites the case of a woman who dated her pregnancy from March,
1848, and which proceeded normally for nine months, but no labor
supervened at this time and the menses reappeared. In March, 1849, she
passed a few fetal bones by the rectum, and in May, 1855, she died. At
the necropsy the uterus was found to contain the remains of a fully
developed fetus, minus the portions discharged through a fistulous
connection between the uterine cavity and the rectum. In this case
there had been retention of a fully developed fetus for nine years. Cox
describes the case of a woman who was pregnant seven months, and who
was seized with convulsions; the supposed labor-pains passed off, and
after death the fetus was found in the womb, having lain there for five
years. She had an early return of the menses, and these recurred
regularly for four years. Dewees quotes two cases, in one of which the
child was carried twenty months in the uterus; in the other, the mother
was still living two years and five months after fecundation. Another
case was in a woman of sixty, who had conceived at twenty-six, and
whose fetus was found, partly ossified, in the uterus after death.
There are many narratives of the long continuation of fetal movements,
and during recent years, in the Southern States, there was quite a
prevalence of this kind of imposters. Many instances of the exhibition
of fetal movements in the bellies of old negro women have been noticed
by the lay journals, but investigation proves them to have been nothing
more than an exceptional control over the abdominal muscles, with the
ability to simulate at will the supposed fetal jerks. One old woman
went so far as to show the fetus dancing to the music of a banjo with
rhythmical movements. Such imposters flourished best in the regions
given to "voodooism." We can readily believe how easy the deception
might be when we recall the exact simulation of the fetal movements in
instances of pseudocyesis.
The extraordinary diversity of reports concerning the duration of
pregnancy has made this a much mooted question. Many opinions relative
to the longest and shortest period of pregnancy, associated with
viability of the issue, have been expressed by authors on medical
jurisprudence. There is perhaps no information more unsatisfactory or
uncertain. Mistakes are so easily made in the date of the occurrence of
pregnancy, or in the date of conception, that in the remarkable cases
we can hardly accept the propositions as worthy evidence unless
associated with other and more convincing facts, such as the appearance
and stage of development of the fetus, or circumstances making
conception impossible before or after the time mentioned, etc. It will
be our endeavor to cite the more seemingly reliable instances of the
anomalies of the time or duration of pregnancy reported in reputable
periodicals or books.
Short Pregnancies.--Hasenet speaks of the possibility of a living birth
at four months; Capuron relates the instance of Fortunio Liceti, who
was said to have been born at the end of four and a half months and
lived to complete his twenty-fourth year. In the case of the Marechal
de Richelieu, the Parliament of Paris decreed that an infant of five
months possessed that capability of living the ordinary period of
existence, i.e., the "viabilite," which the law of France requires for
the establishment of inheritance. In his seventh book Pliny gives
examples of men who were born out of time. Jonston gives instances of
births at five, six, seven, and eight months. Bonnar quotes 5 living
births before the one hundred and fiftieth day; 1 of one hundred and
twenty-five days; 1 of one hundred and twenty days; 1 of one hundred
and thirty-three days, surviving to twenty-one months; and 1 of one
hundred and thirty-five days' pregnancy surviving to eighty years.
Maisonneuve describes a case in which abortion took place at four and a
half months; he found the fetus in its membranes two hours after
delivery, and, on laying the membranes open, saw that it was living. He
applied warmth, and partly succeeded in restoring it; for a few minutes
respiratory movements were performed regularly, but it died in six
hours. Taylor quotes Carter concerning the case of a fetus of five
months which cried directly after it was born, and in the half hour it
lived it tried frequently to breathe. He also quotes Davies, mentioning
an instance of a fetus of five months, which lived twelve hours,
weighing 2 pounds, and measuring 12 inches, and which cried vigorously.
The pupillary membrane was entire, the testes had not descended, and
the head was well covered with hair. Usher speaks of a woman who in
1876 was delivered of 2 male children on the one hundred and
thirty-ninth day; both lived for an hour; the first weighed 10 ounces 6
drams and measured 9 3/4 inches; the other 10 ounces 7 drams, with the
same length as the first. Routh speaks of a Mrs. F----, aged
thirty-eight, who had borne 9 children and had had 3 miscarriages, the
last conception terminating as such. Her husband was away, and returned
October 9, 1869. She did not again see her husband until the 3d or 4th
of January. The date of quickening was not observed, and the child was
born June 8, 1870. During gestation she was much frightened by a rat.
The child was weak, the testes undescended, and it lived but eighteen
days, dying of symptoms of atrophy. The parents were poor, of excellent
character, and although, according to the evidence, this pregnancy
lasted but twenty-two weeks and two days, there was absolutely no
reason to suspect infidelity.
Ruttel speaks of a child of five months who lived twenty-four hours;
and he saw male twins born at the sixth month weighing 3 pounds each
who were alive and healthy a year after. Barker cites the case of a
female child born on the one hundred and fifty-eighth day that weighed
1 pound and was 11 inches long. It had rudimentary nails, very little
hair on the head, its eyelids were closed, and the skin much shriveled;
it did not suckle properly, and did not walk until nineteen months old.
Three and a half years after, the child was healthy and thriving, but
weighed only 29 1/2 pounds. At the time of birth it was wrapped up in a
box and placed before the fire. Brouzet speaks of living births of from
five to six months' pregnancy, and Kopp speaks of a six months' child
which lived four days. The Ephemerides contains accounts of living
premature births.
Newinton describes a pregnancy of five months terminating with the
birth of twins, one of whom lived twenty minutes and the other fifteen.
The first was 11 1/2 inches long, and weighed 1 pound 3 1/2 ounces, and
the other was 11 inches long, and weighed 1 pound. There is a recent
instance of premature birth following a pregnancy of between five and a
half and six months, the infant weighing 955 grams. One month after
birth, through the good offices of the wet-nurse and M. Villemin, who
attended the child and who invented a "couveuse" for the occasion, it
measured 38 cm. long.
Moore is accredited with the trustworthy report of the case of a woman
who bore a child at the end of the fifth month weighing 1 1/2 pounds
and measuring 9 inches. It was first nourished by dropping liquid food
into its mouth; and at the age of fifteen months it was healthy and
weighed 18 pounds. Eikam saw a case of abortion at the fifth month in
which the fetus was 6 inches in length and weighed about 8 ounces. The
head was sufficiently developed and the cranial bones considerably
advanced in ossification. He tied the cord and placed the fetus in warm
water. It drew up its feet and arms and turned its head from one side
to the other, opening its mouth and trying to breathe. It continued in
this wise for an hour, the action of the heart being visible ten
minutes after the movements ceased. From its imperfectly developed
genitals it was supposed to have been a female. Professor J. Muller, to
whom it was shown, said that it was not more than four months old, and
this coincided with the mother's calculation.
Villemin before the Societe Obstetricale et Gynecologique reported the
case of a two-year-old child, born in the sixth month of pregnancy.
That the child had not had six months of intrauterine life he could
vouch, the statement being borne out by the last menstrual period of
the mother, the date of the first fetal movements, the child's weight,
which was 30 1/2 ounces, and its appearance. Budin had had this infant
under observation from the beginning and corroborated Villemin's
statements. He had examined infants of six or seven months that had
cried and lived a few days, and had found the alveolar cavities filled
with epithelial cells, the lung sinking when placed in a vessel of
water. Charpentier reported a case of premature birth in his practice,
the child being not more than six and a half months and weighing 33 1/2
ounces. So sure was he that it would not live that he placed it in a
basin while he attended to the mother. After this had been done, the
child being still alive, he wrapped it in cotton and was surprised next
day to find it alive. It was then placed in a small, well-heated room
and fed with a spoon on human milk; on the twelfth day it could take
the breast, since which time it thrived and grew.
There is a case on record of a child viable at six months and twenty
days. The mother had a miscarriage at the beginning of 1877, after
which menstruation became regular, appearing last from July 3 to 9,
1877. On January 28, 1878, she gave birth to a male infant, which was
wrapped in wadding and kept at an artificial temperature. Being unable
to suckle, it was fed first on diluted cow's milk. It was so small at
birth that the father passed his ring over the foot almost to the knee.
On the thirteenth day it weighed 1250 grams, and at the end of a week
it was taking the breast. In December, 1879, it had 16 teeth, weighed
10 kilograms, walked with agility, could pronounce some words, and was
especially intelligent. Capuron relates an instance of a child born
after a pregnancy of six and a half months and in excellent health at
two years, and another living at ten years of the same age at birth.
Tait speaks of a living female child, born on the one hundred and
seventy-ninth day, with no nails on its fingers or toes, no hair, the
extremities imperfectly developed, and the skin florid and thin. It was
too feeble to grasp its mother's nipple, and was fed for three weeks by
milk from the breast through a quill. At forty days it weighed 3 pounds
and measured 13 inches. Before the expiration of three months it died
of measles. Dodd describes a case in which the catamenia were on the
24th of June, 1838, and continued a week; the woman bore twins on
January 11, 1839, one of which survived, the other dying a few minutes
after birth. She was never irregular, prompt to the hour, and this
fact, coupled with the diminutive size of the children, seemed to
verify the duration of the pregnancy. In 1825, Baber of Buxur, India,
spoke of a child born at six and a half months, who at the age of fifty
days weighed 1 pound and 13 ounces and was 14 inches long. The longest
circumference of the head was 10 inches and the shortest 9.1 inches.
The child suckled freely and readily. In Spaeth's clinic there was a
viable infant at six and a half months weighing 900 grams. Spaeth says
that he has known a child of six months to surpass in eventual
development its brothers born at full term.
In some cases there seems to be a peculiarity in women which manifests
itself by regular premature births. La Motte, van Swieten, and Fordere
mention females who always brought forth their conceptions at the
seventh month.
The incubator seems destined to be the future means of preserving these
premature births. Several successful cases have been noticed, and by
means of an incubator Tarnier succeeded in raising infants which at the
age of six months were above the average. A full description of the
incubator may be found. The modified Auvard incubator is easily made;
the accompanying illustrations (Figs. 5, 6, and 7) explain its
mechanism. Several improved incubators have been described in recent
years, but the Auvard appears to be the most satisfactory.
The question of retardation of labor, like that of premature birth, is
open to much discussion, and authorities differ as to the limit of
protraction with viability. Aulus Gellius says that, after a long
conversation with the physicians and wise men, the Emperor Adrian
decided in a case before him, that of a woman of chaste manners and
irreproachable character, the child born eleven months after her
husband's death was legitimate. Under the Roman law the Decenviri
established that a woman may bear a viable child at the tenth month of
pregnancy. Paulus Zacchias, physician to Pope Innocent X, declared that
birth may be retarded to the tenth month, and sometimes to a longer
period. A case was decided in the Supreme Court of Friesland, a
province in the northern part of the Netherlands, October, 1634, in
which a child born three hundred and thirty-three days after the death
of the husband was pronounced legitimate. The Parliament of Paris was
gallant enough to come to the rescue of a widow and save her reputation
by declaring that a child born after a fourteen months' gestation was
legitimate. Bartholinus speaks of an unmarried woman of Leipzig who was
delivered after a pregnancy of sixteen months. The civil code of France
provides that three hundred days shall constitute the longest period of
the legitimacy of an infant; the Scottish law, three hundred days; and
the Prussian law, three hundred and one days.
There are numerous cases recorded by the older writers. Amman has one
of twelve months' duration; Enguin, one of twelve months'; Buchner, a
case of twelve months'; Benedictus, one of fourteen months'; de Blegny,
one of nineteen months'; Marteau, Osiander, and others of forty-two and
forty-four weeks'; and Stark's Archives, one of forty-five weeks',
living, and also another case of forty-four weeks'. An incredible case
is recorded of an infant which lived after a three years' gestation.
Instances of twelve months' duration are also recorded. Jonston quotes
Paschal in relating an instance of birth after pregnancy of
twenty-three months; Aventium, one after two years; and Mercurialis, a
birth after a four years' gestation--which is, of course, beyond belief.
Thormeau writes from Tours, 1580, of a case of gestation prolonged to
the twenty-third month, and Santorini, at Venice, in 1721, describes a
similar case, the child reaching adult life. Elvert records a case of
late pregnancy, and Henschel one of forty-six weeks, but the fetus was
dead. Schneider cites an instance of three hundred and eight days'
duration. Campbell says that Simpson had cases of three hundred and
nineteen, three hundred and thirty-two, and three hundred and
thirty-six days'; Meigs had one of four hundred and twenty. James Reid,
in a table of 500 mature births, gives 14 as being from three hundred
and two to three hundred and fifteen days'.
Not so long ago a jury rendered a verdict of guilty of fornication and
bastardy when it was alleged that the child was born three hundred and
seventeen days after intercourse. Taylor relates a case of pregnancy in
which the wife of a laborer went to America three hundred and
twenty-two days before the birth. Jaffe describes an instance of the
prolongation of pregnancy for three hundred and sixty-five days, in
which the developments and measurements corresponded to the length of
protraction. Bryan speaks of a woman of twenty-five who became pregnant
on February 10, 1876, and on June 17th felt motion. On July 28th she
was threatened with miscarriage, and by his advice the woman weaned the
child at the breast. She expected to be confined the middle of
November, 1876, but the expected event did not occur until April 26,
1877, nine months after the quickening and four hundred and forty days
from the time of conception. The boy was active and weighed nine
pounds. The author cites Meigs' case, and also one of Atlee's, at three
hundred and fifty-six days.
Talcott, Superintendent of the State Homeopathic Asylum for the Insane,
explained the pregnancy of an inmate who had been confined for four
years in this institution as one of protracted labor. He said that many
such cases have been reported, and that something less than two years
before he had charge of a case in which the child was born. He made the
report to the New York Senate Commission on Asylums for the Insane as
one of three years' protraction. Tidd speaks of a woman who was
delivered of a male child at term, and again in ten months delivered of
a well-developed male child weighing 7 1/4 pounds; he relates the
history of another case, in Clifton, W. Va., of a woman expecting
confinement on June 1st going over to September 16th, the fetus being
in the uterus over twelve months, and nine months after quickening was
felt.
Two extraordinary cases are mentioned, one in a woman of thirty-five,
who expected to be confined April 24, 1883. In May she had a few
labor-pains that passed away, and during the next six months she
remained about as large as usual, and was several times thought to be
in the early stages of labor. In September the os dilated until the
first and second fingers could be passed directly to the head. This
condition lasted about a month, but passed away. At times during the
last nine months of pregnancy she was almost unable to endure the
movements of the child. Finally, on the morning of November 6th, after
a pregnancy of four hundred and seventy-six days, she was delivered of
a male child weighing 13 pounds. Both the mother and child did well
despite the use of chloroform and forceps. The other case was one
lasting sixteen months and twenty days.
In a rather loose argument, Carey reckons a case of three hundred and
fifty days. Menzie gives an instance in a woman aged twenty-eight, the
mother of one child, in whom a gestation was prolonged to the
seventeenth month. The pregnancy was complicated by carcinoma of the
uterus. Ballard describes the case of a girl of sixteen years and six
months, whose pregnancy, the result of a single intercourse, lasted
three hundred and sixty days. Her labor was short and easy for a
primipara, and the child was of the average size. Mackenzie cites the
instance of a woman aged thirty-two, a primipara, who had been married
ten years and who always had been regular in menstruation. The menses
ceased on April 28, 1888, and she felt the child for the first time in
September. She had false pains in January, 1889, and labor did not
begin until March 8th, lasting sixty-six hours. If all these statements
are correct, the probable duration of this pregnancy was eleven months
and ten days.
Lundie relates an example of protracted gestation of eleven months, in
which an anencephalous fetus was born; and Martin of Birmingham
describes a similar case of ten and a half months' duration.
Raux-Tripier has seen protraction to the thirteenth month. Enguin
reports an observation of an accouchement of twins after a pregnancy
that had been prolonged for eleven months. Resnikoff mentions a
pregnancy of eleven months' duration in an anemic secundipara. The case
had been under his observation from the beginning of pregnancy; the
patient would not submit to artificial termination at term, which he
advised. After a painful labor of twenty-four hours a macerated and
decomposed child was born, together with a closely-adherent placenta.
Tarnier reports an instance of partus serotinus in which the product of
conception was carried in the uterus forty days after term. The fetus
was macerated but not putrid, and the placenta had undergone fatty
degeneration. At a recent meeting of the Chicago Gynecological Society,
Dr. F. A. Stahl reported the case of a German-Bohemian woman in which
the fifth pregnancy terminated three hundred and two days after the
last menstruation. Twenty days before there had occurred pains similar
to those of labor, but they gradually ceased. The sacral promontory was
exaggerated, and the anteroposterior pelvic diameter of the inlet in
consequence diminished. The fetus was large and occupied the first
position. Version was with difficulty effected and the passage of the
after-coming head through the superior strait required expression and
traction, during which the child died. The mother suffered a deep
laceration of the perineum involving an inch of the wall of the rectum.
Among others reporting instances of protracted pregnancy are Collins,
eleven months; Desbrest, eighteen months; Henderson, fifteen months;
Jefferies, three hundred and fifty-eight days, and De la Vergne gives
the history of a woman who carried an infant in her womb for
twenty-nine months; this case may possibly belong under the head of
fetus long retained in the uterus.
Unconscious Pregnancy.--There are numerous instances of women who have
had experience in pregnancy unconsciously going almost to the moment of
delivery, yet experiencing none of the usual accompanying symptoms of
this condition. Crowell speaks of a woman of good social position who
had been married seven years, and who had made extensive preparations
for a long journey, when she was seized with a "bilious colic," and, to
her dismay and surprise, a child was born before the arrival of the
doctor summoned on account of her sudden colic and her inability to
retain her water. A peculiar feature of this case was the fact that
mental disturbance set in immediately afterward, and the mother became
morbid and had to be removed to an asylum, but recovered in a few
months. Tanner saw a woman of forty-two who had been suffering with
abdominal pains. She had been married three years and had never been
pregnant. Her catamenia were very scant, but this was attributed to her
change of life. She had conceived, had gone to the full term of
gestation, and was in labor ten hours without any suspicion of
pregnancy. She was successfully delivered of a girl, which occasioned
much rejoicing in the household.
Tasker of Kendall's Mills, Me., reports the case of a young married
woman calling him for bilious colic. He found the stomach slightly
distended and questioned her about the possibility of pregnancy. Both
she and her husband informed him that such could not be the case, as
her courses had been regular and her waist not enlarged, as she had
worn a certain corset all the time. There were no signs of quickening,
no change in the breasts, and, in fact, none of the usual signs of
pregnancy present. He gave her an opiate, and to her surprise, in about
six hours she was the mother of a boy weighing five pounds. Both the
mother and child made a good recovery. Duke cites the instance of a
woman who supposed that she was not pregnant up to the night of her
miscarriage. She had menstruated and was suckling a child sixteen
months old. During the night she was attacked with pains resembling
those of labor and a fetus slipped into the vagina without any
hemorrhage; the placenta came away directly afterward. In this peculiar
case the woman was menstruating regularly, suckling a child, and at the
same time was unconsciously pregnant.
Isham speaks of a case of unconscious pregnancy in which extremely
small twins were delivered at the eighth month. Fox cites an instance
of a woman who had borne eight children, and yet unconscious of
pregnancy. Merriman speaks of a woman forty years of age who had not
borne a child for nine years, but who suddenly gave birth to a stout,
healthy boy without being cognizant of pregnancy. Dayral tells of a
woman who carried a child all through pregnancy, unconscious of her
condition, and who was greatly surprised at its birth. Among the French
observers speaking of pregnancy remaining unrecognized by the mother
until the period of accouchement, Lozes and Rhades record peculiar
cases; and Mouronval relates an instance in which a woman who had borne
three children completely ignored the presence of pregnancy until the
pains of labor were felt. Fleishman and Munzenthaler also record
examples of unconscious pregnancy.
Pseudocyesis.--On the other hand, instances of pregnancy with imaginary
symptoms and preparations for birth are sometimes noticed, and many
cases are on record. In fact, nearly every text-book on obstetrics
gives some space to the subject of pseudocyesis. Suppression of the
menses, enlargement of the abdomen, engorgement of the breasts,
together with the symptoms produced by the imagination, such as nausea,
spasmodic contraction of the abdomen, etc., are for the most part the
origin of the cases of pseudocyesis. Of course, many of the cases are
not examples of true pseudocyesis, with its interesting phenomena, but
instances of malingering for mercenary or other purposes, and some are
calculated to deceive the most expert obstetricians by their tricks.
Weir Mitchell delineates an interesting case of pseudocyesis as
follows: "A woman, young, or else, it may be, at or past the
climacteric, eagerly desires a child or is horribly afraid of becoming
pregnant. The menses become slight in amount, irregular, and at last
cease or not. Meanwhile the abdomen and breasts enlarge, owing to a
rapid taking on of fat, and this is far less visible elsewhere. There
comes with this excess of fat the most profound conviction of the fact
of pregnancy. By and by the child is felt, the physician takes it for
granted, and this goes on until the great diagnostician, Time, corrects
the delusion. Then the fat disappears with remarkable speed, and the
reign of this singular simulation is at an end." In the same article,
Dr. Mitchell cites the two following cases under his personal
observation: "I was consulted by a lady in regard to a woman of thirty
years of age, a nurse in whom she was interested. This person had been
married some three years to a very old man possessed of a considerable
estate. He died, leaving his wife her legal share and the rest to
distant cousins, unless the wife had a child. For two months before he
died the woman, who was very anemic, ceased to menstruate. She became
sure that she was pregnant, and thereupon took on flesh at a rate and
in a way which seemed to justify her belief. Her breasts and abdomen
were the chief seats of this overgrowth. The menses did not return, her
pallor increased; the child was felt, and every preparation made for
delivery. At the eighth month a physician made an examination and
assured her of the absence of pregnancy. A second medical opinion
confirmed the first, and the tenth month found her of immense size and
still positive as to her condition. At the twelfth month her menstrual
flow returned, and she became sure it was the early sign of labor. When
it passed over she became convinced of her error, and at once dropped
weight at the rate of half a pound a day despite every effort to limit
the rate of this remarkable loss. At the end of two months she had
parted with fifty pounds and was, on the whole, less anemic. At this
stage I was consulted by letter, as the woman had become exceedingly
hysteric. This briefly stated case, which occurred many years ago, is a
fair illustration of my thesis.
"Another instance I saw when in general practice. A lady who had
several children and suffered much in her pregnancies passed five years
without becoming impregnated. Then she missed a period, and had, as
usual, vomiting. She made some wild efforts to end her supposed
pregnancy, and failing, acquiesced in her fate. The menses returned at
the ninth month and were presumed to mean labor. Meanwhile she vomited,
up to the eighth month, and ate little. Nevertheless, she took on fat
so as to make the abdomen and breasts immense and to excite unusual
attention. No physician examined her until the supposed labor began,
when, of course, the truth came out. She was pleased not to have
another child, and in her case, as in all the others known to me, the
fat lessened as soon as the mind was satisfied as to the non-existence
of pregnancy. As I now recall the facts, this woman was not more than
two months in getting rid of the excess of adipose tissue. Dr. Hirst
tells me he has met with cases of women taking on fat with cessation of
the menses, and in which there was also a steady belief in the
existence of pregnancy. He has not so followed up these cases as to
know if in them the fat fell away with speed when once the patient was
assured that no child existed within her."
Hirst, in an article on the difficulties in the diagnosis of pregnancy,
gives several excellent photographs showing the close resemblance
between several pathologic conditions and the normal distention of the
abdomen in pregnancy. A woman who had several children fell sick with a
chest-affection, followed by an edema. For fifteen months she was
confined to her bed, and had never had connection with her husband
during that time. Her menses ceased; her mammae became engorged and
discharged a serous lactescent fluid; her belly enlarged, and both she
and her physician felt fetal movements in her abdomen. As in her
previous pregnancies, she suffered nausea. Naturally, a suspicion as to
her virtue came into her husband's mind, but when he considered that
she had never left her bed for fifteen months he thought the pregnancy
impossible. Still the wife insisted that she was pregnant and was
confirmed in the belief by a midwife. The belly continued to increase,
and about eleven months after the cessation of the menses she had the
pains of labor. Three doctors and an accoucheur were present, and when
they claimed that the fetal head presented the husband gave up in
despair; but the supposed fetus was born shortly after, and proved to
be only a mass of hydatids, with not the sign of a true pregnancy.
Girard of Lyons speaks of a female who had been pregnant several times,
but again experienced the signs of pregnancy. Her mammae were engorged
with a lactescent fluid, and she felt belly-movements like those of a
child; but during all this time she had regular menstruation. Her
abdomen progressively increased in size, and between the tenth and
eleventh months she suffered what she thought to be labor-pains. These
false pains ceased upon taking a bath, and with the disappearance of
the other signs was dissipated the fallacious idea of pregnancy.
There is mentioned an instance of medicolegal interest of a young girl
who showed all the signs of pregnancy and confessed to her parents that
she had had commerce with a man. The parents immediately prosecuted the
seducer by strenuous legal methods, but when her ninth month came, and
after the use of six baths, all the signs of pregnancy vanished. Harvey
cites several instances of pseudocyesis, and says we must not rashly
determine of the the inordinate birth before the seventh or after the
eleventh month. In 1646 a woman, after having laughed heartily at the
jests of an ill-bred, covetous clown, was seized with various movements
and motions in her belly like those of a child, and these continued for
over a month, when the courses appeared again and the movements ceased.
The woman was certain that she was pregnant.
The most noteworthy historic case of pseudocyesis is that of Queen Mary
of England, or "Bloody Mary," as she was called. To insure the
succession of a Catholic heir, she was most desirous of having a son by
her consort, Philip, and she constantly prayed and wished for
pregnancy. Finally her menses stopped; the breasts began to enlarge
and became discolored around the nipples. She had morning-sickness of a
violent nature and her abdomen enlarged. On consultation with the
ladies of her court, her opinion of pregnancy was strongly confirmed.
Her favorite amusement then was to make baby-clothes and count on her
fingers the months of pregnancy. When the end of the ninth month
approached, the people were awakened one night by the joyous peals of
the bells of London announcing the new heir. An ambassador had been
sent to tell the Pope that Mary could feel the new life within her, and
the people rushed to St. Paul's Cathedral to listen to the venerable
Archbishop of Canterbury describe the baby-prince and give thanks for
his deliverance. The spurious labor pains passed away, and after being
assured that no real pregnancy existed in her case, Mary went into
violent hysterics, and Philip, disgusted with the whole affair,
deserted her; then commenced the persecution of the Protestants, which
blighted the reign.
Putnam cites the case of a healthy brunet, aged forty, the mother of
three children. She had abrupt vertical abdominal movements, so strong
as to cause her to plunge and sway from side to side. Her breasts were
enlarged, the areolae dark, and the uterus contained an elastic tumor,
heavy and rolling under the hand. Her abdomen progressively enlarged to
the regular size of matured gestation; but the extrauterine pregnancy,
which was supposed to have existed, was not seen at the autopsy,
nothing more than an enlarged liver being found. The movement was due
to spasmodic movements of the abdominal muscles, the causes being
unknown. Madden gives the history of a primipara of twenty-eight,
married one year, to whom he was called. On entering the room he was
greeted by the midwife, who said she expected the child about 8 P.M.
The woman was lying in the usual obstetric position, on the left side,
groaning, crying loudly, and pulling hard at a strap fastened to the
bed-post. She had a partial cessation of menses, and had complained of
tumultuous movements of the child and overflow of milk from the
breasts. Examination showed the cervix low down, the os small and
circular, and no signs of pregnancy in the uterus. The abdomen was
distended with tympanites and the rectum much dilated with accumulated
feces. Dr. Madden left her, telling her that she was not pregnant, and
when she reappeared at his office in a few days, he reassured her of
the nonexistence of pregnancy; she became very indignant, triumphantly
squeezed lactescent fluid from her breasts, and, insisting that she
could feel fetal movements, left to seek a more sympathetic accoucheur.
Underhill, in the words of Hamilton, describes a woman as "having
acquired the most accurate description of the breeding symptoms, and
with wonderful facility imagined that she had felt every one of them."
He found the woman on a bed complaining of great labor-pains, biting a
handkerchief, and pulling on a cloth attached to her bed. The finger on
the abdomen or vulva elicited symptoms of great sensitiveness. He told
her she was not pregnant, and the next day she was sitting up, though
the discharge continued, but the simulated throes of labor, which she
had so graphically pictured, had ceased.
Haultain gives three examples of pseudocyesis, the first with no
apparent cause, the second due to carcinoma of the uterus, while in the
third there was a small fibroid in the anterior wall of the uterus.
Some cases are of purely nervous origin, associated with a purely
muscular distention of the abdomen. Clay reported a case due to
ascites. Cases of pseudocyesis in women convicted of murder are not
uncommon, though most of them are imposters hoping for an extra lease
of life.
Croon speaks of a child seven years old on whom he performed ovariotomy
for a round-celled sarcoma. She had been well up to May, but since then
she had several times been raped by a boy, in consequence of which she
had constant uterine hemorrhage. Shortly after the first coitus her
abdomen began to enlarge, the breasts to develop, and the areolae to
darken. In seven months the abdomen presented the signs of pregnancy,
but the cervix was soft and patulous; the sound entered three inches
and was followed by some hemorrhage. The child was well developed, the
mons was covered with hair, and all the associate symptoms tended to
increase the deception.
Sympathetic Male Nausea of Pregnancy.--Associated with pregnancy there
are often present morning-nausea and vomiting as prominent and reliable
symptoms. Vomiting is often so excessive as to be provocative of most
serious issue and even warranting the induction of abortion. This fact
is well known and has been thoroughly discussed, but with it is
associated an interesting point, the occasional association of the same
symptoms sympathetically in the husband. The belief has long been a
superstition in parts of Great Britain, descending to America, and even
exists at the present day. Sir Francis Bacon has written on this
subject, the substance of his argument being that certain loving
husbands so sympathize with their pregnant wives that they suffer
morning-sickness in their own person. No less an authority than S. Weir
Mitchell called attention to the interesting subject of sympathetic
vomiting in the husband in his lectures on nervous maladies some years
ago. He also quotes the following case associated with pseudocyesis:--
"A woman had given birth to two female children. Some years passed and
her desire for a boy was ungratified. Then she missed her flow once,
and had thrice after this, as always took place with her when pregnant,
a very small but regular loss. At the second month morning-vomiting
came on as usual with her. Meanwhile she became very fat, and as the
growth was largely, in fact excessively, abdominal, she became easily
sure of her condition. She was not my patient, but her husband
consulted me as to his own morning-sickness, which came on with the
first occurrence of this sign in his wife, as had been the case twice
before in her former pregnancies. I advised him to leave home, and this
proved effectual. I learned later that the woman continued to gain
flesh and be sick every morning until the seventh month. Then
menstruation returned, an examination was made, and when sure that
there was no possibility of her being pregnant she began to lose flesh,
and within a few months regained her usual size."
Hamill reports an instance of morning-sickness in a husband two weeks
after the appearance of menstruation in the wife for the last time. He
had daily attacks, and it was not until the failure of the next menses
that the woman had any other sign of pregnancy than her husband's
nausea. His nausea continued for two months, and was the same as that
which he had suffered during his wife's former pregnancies, although
not until both he and his wife became aware of the existence of
pregnancy. The Lancet describes a case in which the husband's nausea
and vomiting, as well as that of the wife, began and ended
simultaneously. Judkins cites an instance of a man who was sick in the
morning while his wife was carrying a child. This occurred during every
pregnancy, and the man related that his own father was similarly
affected while his mother was in the early months of pregnancy with
him, showing an hereditary predisposition.
The perverted appetites and peculiar longings of pregnant women furnish
curious matter for discussion. From the earliest times there are many
such records. Borellus cites an instance, and there are many others, of
pregnant women eating excrement with apparent relish. Tulpius, Sennert,
Langius, van Swieten, a Castro, and several others report depraved
appetites. Several writers have seen avidity for human flesh in such
females. Fournier knew a woman with an appetite for the blood of her
husband. She gently cut him while he lay asleep by her side and sucked
blood from the wounds--a modern "Succubus." Pare mentions the perverted
appetites of pregnant women, and says that they have been known to eat
plaster, ashes, dirt, charcoal, flour, salt, spices, to drink pure
vinegar, and to indulge in all forms of debauchery. Plot gives the case
of a woman who would gnaw and eat all the linen off her bed. Hufeland's
Journal records the history of a case of a woman of thirty-two, who had
been married ten years, who acquired a strong taste for charcoal, and
was ravenous for it. It seemed to cheer her and to cure a supposed
dyspepsia. She devoured enormous quantities, preferring hard-wood
charcoal. Bruyesinus speaks of a woman who had a most perverted
appetite for her own milk, and constantly drained her breasts;
Krafft-Ebing cites a similar case. Another case is that of a pregnant
woman who had a desire for hot and pungent articles of food, and who in
a short time devoured a pound of pepper. Scheidemantel cites a case in
which the perverted appetite, originating in pregnancy, became
permanent, but this is not the experience of most observers. The
pregnant wife of a farmer in Hassfort-on-the-Main ate the excrement of
her husband.
Many instances could be quoted, some in which extreme cases of
polydipsia and bulimia developed; these can be readily attributed to
the increased call for liquids and food. Other cases of diverse new
emotions can be recalled, such as lasciviousness, dirty habits,
perverted thoughts, and, on the other hand, extreme piety, chastity,
and purity of the mind. Some of the best-natured women are when
pregnant extremely cross and irritable and many perversions of
disposition are commonly noticed in pregnancy. There is often a
longing for a particular kind of food or dish for which no noticeable
desire had been displayed before.
Maternal Impressions.--Another curious fact associated with pregnancy
is the apparent influence of the emotions of the mother on the child in
utero. Every one knows of the popular explanation of many birth-marks,
their supposed resemblance to some animal or object seen by the mother
during pregnancy, etc. The truth of maternal impressions, however,
seems to be more firmly established by facts of a substantial nature.
There is a natural desire to explain any abnormality or anomaly of the
child as due to some incident during the period of the mother's
pregnancy, and the truth is often distorted and the imagination heavily
drawn upon to furnish the satisfactory explanation. It is the customary
speech of the dime-museum lecturer to attribute the existence of some
"freak" to an episode in the mother's pregnancy. The poor
"Elephant-man" firmly believed his peculiarity was due to the fact that
his mother while carrying him in utero was knocked down at the circus
by an elephant. In some countries the exhibition of monstrosities is
forbidden because of the supposed danger of maternal impression. The
celebrated "Siamese Twins" for this reason were forbidden to exhibit
themselves for quite a period in France.
We shall cite only a few of the most interesting cases from medical
literature. Hippocrates saved the honor of a princess, accused of
adultery with a negro because she bore a black child, by citing it as a
case of maternal impression, the husband of the princess having placed
in her room a painting of a negro, to the view of which she was
subjected during the whole of her pregnancy. Then, again, in the
treatise "De Superfoetatione" there occurs the following distinct
statement: "If a pregnant woman has a longing to eat earth or coals,
and eats of them, the infant which is born carries on its head the mark
of these things." This statement, however, occurs in a work which is
not mentioned by any of the ancient authorities, and is rejected by
practically all the modern ones; according to Ballantyne, there is,
therefore, no absolute proof that Hippocrates was a believer in one of
the most popular and long-persisting beliefs concerning fetal
deformities.
In the explanation of heredity, Hippocrates states "that the body of
the male as well as that of the female furnishes the semen. That which
is weak (unhealthy) is derived from weak (unhealthy) parts, that which
is strong (healthy) from strong (healthy) parts, and the fetus will
correspond to the quality of the semen. If the semen of one part come
in greater quantity from the male than from the female, this part will
resemble more closely the father; if, however, it comes more from the
female, the part will rather resemble the mother. If it be true that
the semen comes from both parents, then it is impossible for the whole
body to resemble either the mother or the father, or neither the one
nor the other in anything, but necessarily the child will resemble both
the one and the other in something. The child will most resemble the
one who contributes most to the formation of the parts." Such was the
Hippocratic theory of generation and heredity, and it was ingeniously
used to explain the hereditary nature of certain diseases and
malformations. For instance, in speaking of the sacred disease
(epilepsy), Hippocrates says: "Its origin is hereditary, like that of
other diseases; for if a phlegmatic person be born of a phlegmatic, and
a bilious of a bilious, and a phthisical of a phthisical, and one
having spleen disease of another having disease of the spleen, what is
to hinder it from happening that where the father and mother were
subject to this disease certain of their offspring should be so
affected also? As the semen comes from all parts of the body, healthy
particles will come from healthy parts, and unhealthy from unhealthy
parts."
According to Pare, Damascene saw a girl with long hair like a bear,
whose mother had constantly before her a picture of the hairy St. John.
Pare also appends an illustration showing the supposed resemblance to a
bear. Jonston quotes a case of Heliodorus; it was an Ethiopian, who by
the effect of the imagination produced a white child. Pare describes
this case more fully: "Heliodorus says that Persina, Queen of Ethiopia,
being impregnated by Hydustes, also an Ethiopian, bore a daughter with
a white skin, and the anomaly was ascribed to the admiration that a
picture of Andromeda excited in Persina throughout the whole of the
pregnancy." Van Helmont cites the case of a tailor's wife at Mechlin,
who during a conflict outside her house, on seeing a soldier lose his
hand at her door, gave birth to a daughter with one hand, the other
hand being a bleeding stump; he also speaks of the case of the wife of
a merchant at Antwerp, who after seeing a soldier's arm shot off at the
siege of Ostend gave birth to a daughter with one arm. Plot speaks of a
child bearing the figure of a mouse; when pregnant, the mother had been
much frightened by one of these animals. Gassendus describes a fetus
with the traces of a wound in the same location as one received by the
mother. The Lancet speaks of several cases--one of a child with a face
resembling a dog whose mother had been bitten; one of a child with one
eye blue and the other black, whose mother during confinement had seen
a person so marked; of an infant with fins as upper and lower
extremities, the mother having seen such a monster; and another, a
child born with its feet covered with scalds and burns, whose mother
had been badly frightened by fireworks and a descending rocket. There
is the history of a woman who while pregnant at seven months with her
fifth child was bitten on the right calf by a dog. Ten weeks after, she
bore a child with three marks corresponding in size and appearance to
those caused by the dog's teeth on her leg. Kerr reports the case of a
woman in her seventh month whose daughter fell on a cooking stove,
shocking the mother, who suspected fatal burns. The woman was delivered
two months later of an infant blistered about the mouth and extremities
in a manner similar to the burns of her sister. This infant died on the
third day, but another was born fourteen months later with the same
blisters. Inflammation set in and nearly all the fingers and toes
sloughed of. In a subsequent confinement, long after the mental
agitation, a healthy unmarked infant was born.
Hunt describes a case which has since become almost classic of a woman
fatally burned, when pregnant eight months, by her clothes catching
fire at the kitchen grate. The day after the burns labor began and was
terminated by the birth of a well-formed dead female child, apparently
blistered and burned in extent and in places corresponding almost
exactly to the locations of the mother's injuries. The mother died on
the fourth day.
Webb reports the history of a negress who during a convulsion while
pregnant fell into a fire, burning the whole front of the abdomen, the
front and inside of the thighs to the knees, the external genitals, and
the left arm. Artificial delivery was deemed necessary, and a dead
child, seemingly burned much like its mother, except less intensely,
was delivered. There was also one large blister near the inner canthus
of the eye and some large blisters about the neck and throat which the
mother did not show. There was no history of syphilis nor of any
eruptive fever in the mother, who died on the tenth day with tetanus.
Graham describes a woman of thirty-five, the mother of seven children,
who while pregnant was feeding some rabbits, when one of the animals
jumped at her with its eyes "glaring" upon her, causing a sudden
fright. Her child was born hydrocephalic. Its mouth and face were small
and rabbit-shaped. Instead of a nose, it had a fleshy growth 3/4 inch
long by 1/4 inch broad, directed upward at an angle of 45 degrees. The
space between this and the mouth was occupied by a body resembling an
adult eye. Within this were two small, imperfect eyes which moved
freely while life lasted (ten minutes). The child's integument was
covered with dark, downy, short hair. The woman recovered and afterward
bore two normal children.
Parvin mentions an instance of the influence of maternal impression in
the causation of a large, vivid, red mark or splotch on the face: "When
the mother was in Ireland she was badly frightened by a fire in which
some cattle were burned. Again, during the early months of her
pregnancy she was frightened by seeing another woman suddenly light the
fire with kerosene, and at that time became firmly impressed with the
idea that her child would be marked." Parvin also pictures the
"turtle-man," an individual with deformed extremities, who might be
classed as an ectromelus, perhaps as a phocomelus, or seal-like
monster. According to the story, when the mother was a few weeks
pregnant her husband, a coarse, rough fisherman, fond of rude jokes,
put a large live turtle in the cupboard. In the twilight the wife went
to the cupboard and the huge turtle fell out, greatly startling her by
its hideous appearance as it fell suddenly to the floor and began to
move vigorously.
Copeland mentions a curious case in which a woman was attacked by a
rattlesnake when in her sixth month of pregnancy, and gave birth to a
child whose arm exhibited the shape and action of a snake, and
involuntarily went through snake-like movements. The face and mouth
also markedly resembled the head of a snake.
The teeth were situated like a serpent's fangs. The mere mention of a
snake filled the child (a man of twenty-nine) with great horror and
rage, "particularly in the snake season." Beale gives the history of a
case of a child born with its left eye blackened as by a blow, whose
mother was struck in a corresponding portion of the face eight hours
before confinement. There is on record an account of a young man of
twenty-one suffering from congenital deformities attributed to the fact
that his mother was frightened by a guinea-pig having been thrust into
her face during pregnancy. He also had congenital deformity of the
right auricle. At the autopsy, all the skin, tissues, muscles, and
bones were found involved. Owen speaks of a woman who was greatly
excited ten months previously by a prurient curiosity to see what
appearance the genitals of her brother presented after he had submitted
to amputation of the penis on account of carcinoma. The whole penis had
been removed. The woman stated that from the time she had thus
satisfied herself, her mind was unceasingly engaged in reflecting and
sympathizing on the forlorn condition of her brother. While in this
mental state she gave birth to a son whose penis was entirely absent,
but who was otherwise well and likely to live. The other portions of
the genitals were perfect and well developed. The appearance of the
nephew and the uncle was identical. A most peculiar case is stated by
Clerc as occurring in the experience of Kuss of Strasburg. A woman had
a negro paramour in America with whom she had had sexual intercourse
several times. She was put in a convent on the Continent, where she
stayed two years. On leaving the convent she married a white man, and
nine months after she gave birth to a dark-skinned child. The
supposition was that during her abode in the convent and the nine
months subsequently she had the image of her black paramour constantly
before her. Loin speaks of a woman who was greatly impressed by the
actions of a clown at a circus, and who brought into the world a child
that resembled the fantastic features of the clown in a most striking
manner.
Mackay describes five cases in which fright produced distinct marks on
the fetus. There is a case mentioned in which a pregnant woman was
informed that an intimate friend had been thrown from his horse; the
immediate cause of death was fracture of the skull, produced by the
corner of a dray against which the rider was thrown. The mother was
profoundly impressed by the circumstance, which was minutely described
to her by an eye-witness. Her child at birth presented a red and
sensitive area upon the scalp corresponding in location with the fatal
injury in the rider. The child is now an adult woman, and this area
upon the scalp remains red and sensitive to pressure, and is almost
devoid of hair. Mastin of Mobile, Alabama, reports a curious instance
of maternal impression. During the sixth month of the pregnancy of the
mother her husband was shot, the ball passing out through the left
breast. The woman was naturally much shocked, and remarked to Dr.
Mastin: "Doctor, my baby will be ruined, for when I saw the wound I put
my hands over my face, and got it covered with blood, and I know my
baby will have a bloody face." The child came to term without a bloody
face. It had, however, a well-defined spot on the left breast just
below the site of exit of the ball from its father's chest. The spot
was about the size of a silver half-dollar, and had elevated edges of a
bright red color, and was quite visible at the distance of one hundred
feet. The authors have had personal communication with Dr. Mastin in
regard to this case, which he considers the most positive evidence of a
case of maternal impression that he has ever met.
Paternal Impressions.--Strange as are the foregoing cases, those of
paternal impression eclipse them. Several are on record, but none are
of sufficient authenticity to warrant much discussion on the subject.
Those below are given to illustrate the method of report. Stahl, quoted
by Steinan, 1843, speaks of the case of a child, the father being a
soldier who lost an eye in the war. The child was born with one of its
eyes dried up in the orbit, in this respect presenting an appearance
like that of the father. Schneider says a man whose wife was expecting
confinement dreamt that his oldest son stood beside his bedside with
his genitals much mutilated and bleeding. He awoke in a great state of
agitation, and a few days later the wife was delivered of a child with
exstrophy of the bladder. Hoare recites the curious story of a man who
vowed that if his next child was a daughter he would never speak to it.
The child proved to be a son, and during the whole of the father's life
nothing could induce the son to speak to his father, nor, in fact, to
any other male person, but after the father's death he talked fluently
to both men and women. Clark reports the birth of a child whose father
had a stiff knee-joint, and the child's knee was stiff and bent in
exactly the same position as that of its father.
Telegony.--The influence of the paternal seed on the physical and
mental constitution of the child is well known. To designate this
condition, Telegony is the word that was coined by Weismann in his "Das
Keimplasma," and he defines it as "Infection of the Germ," and, at
another time, as "Those doubtful instances in which the offspring is
said to resemble, not the father, but an early mate of the
mother,"--or, in other words, the alleged influence of a previous sire
on the progeny produced by a subsequent one from the same mother. In a
systematic discussion of telegony before the Royal Medical Society,
Edinburgh, on March 1, 1895, Brunton Blaikie, as a means of making the
definition of telegony plainer by practical example, prefaced his
remarks by citing the classic example which first drew the attention of
the modern scientific world to this phenomenon. The facts of this case
were communicated in a letter from the Earl of Morton to the President
of the Royal Society in 1821, and were as follows: In the year 1816
Lord Morton put a male quagga to a young chestnut mare of 7/8 Arabian
blood, which had never before been bred from. The result was a female
hybrid which resembled both parents. He now sold the mare to Sir Gore
Ousley, who two years after she bore the hybrid put her to a black
Arabian horse. During the two following years she had two foals which
Lord Morton thus describes: "They have the character of the Arabian
breed as decidedly as can be expected when 15/16 of the blood are
Arabian, and they are fine specimens of the breed; but both in their
color and in the hair of their manes they have a striking resemblance
to the quagga. Their color is bay, marked more or less like the quagga
in a darker tint. Both are distinguished by the dark line along the
ridge of the back, the dark stripes across the forehand, and the dark
bars across the back part of the legs." The President of the Royal
Society saw the foals and verified Lord Morton's statement.
"Herbert Spencer, in the Contemporary Review for May, 1893, gives
several cases communicated to him by his friend Mr. Fookes, whom
Spencer says is often appointed judge of animals at agricultural shows.
After giving various examples he goes on to say: 'A friend of mine near
this had a valuable Dachshund bitch, which most unfortunately had a
litter by a stray sheep-dog. The next year the owner sent her on a
visit to a pure Dachshund dog, but the produce took quite as much of
the first father as the second, and the next year he sent her to
another Dachshund, with the same result. Another case: A friend of mine
in Devizes had a litter of puppies unsought for, by a setter from a
favorite pointer bitch, and after this she never bred any true
pointers, no matter what the paternity was.'
"Lord Polwarth, whose very fine breed of Border Leicesters is famed
throughout Britain, and whose knowledge on the subject of breeding is
great, says that 'In sheep we always consider that if a ewe breeds to a
Shrop ram, she is never safe to breed pure Leicesters from, as dun or
colored legs are apt to come even when the sire is a pure Leicester.
This has been proved in various instances, but is not invariable.'"
Hon. Henry Scott says: "Dog-breeders know this theory well; and if a
pure-bred bitch happens to breed to a dog of another breed, she is of
little use for breeding pure-bred puppies afterward. Animals which
produce large litters and go a short time pregnant show this throwing
back to previous sires far more distinctly than others--I fancy dogs
and pigs most of all, and probably horses least. The influence of
previous sires may be carried into the second generation or further, as
I have a cat now which appears to be half Persian (long hair). His dam
has very long hair and every appearance of being a half Persian,
whereas neither have really any Persian blood, as far as I know, but
the grand-dam (a very smooth-haired cat) had several litters by a
half-Persian tom-cat, and all her produce since have showed the
influence retained. The Persian tom-cat died many years ago, and was
the only one in the district, so, although I cannot be absolutely
positive, still I think this case is really as stated."
Breeders of Bedlington terriers wish to breed dogs with as powerful
jaws as possible. In order to accomplish this they put the Bedlington
terrier bitch first to a bull-terrier dog, and get a mongrel litter
which they destroy. They now put the bitch to a Bedlington terrier dog
and get a litter of puppies which are practically pure, but have much
stronger jaws than they would otherwise have had, and also show much of
the gameness of the bull-terrier, thus proving that physiologic as well
as anatomic characters may be transmitted in this way.
After citing the foregoing examples, Blaikie directs his attention to
man, and makes the following interesting remarks:--
"We might expect from the foregoing account of telegony amongst animals
that whenever a black woman had a child to a white man, and then
married a black man, her subsequent children would not be entirely
black. Dr. Robert Balfour of Surinam in 1851 wrote to Harvey that he
was continually noticing amongst the colored population of Surinam
'that if a negress had a child or children by a white, and afterward
fruitful intercourse with a negro, the latter offspring had generally a
lighter color than the parents.' But, as far as I know, this is the
only instance of this observation on record. Herbert Spencer has shown
that when a pure-bred animal breeds with an animal of a mixed breed,
the offspring resembles much more closely the parent of pure blood, and
this may explain why the circumstance recorded by Balfour has been so
seldom noted. For a negro, who is of very pure blood, will naturally
have a stronger influence on the subsequent progeny than an
Anglo-Saxon, who comes of a mixed stock. If this be the correct
explanation, we should expect that when a white woman married first a
black man, and then a white, the children by the white husband would be
dark colored. Unfortunately for the proof of telegony, it is very rare
that a white woman does marry a black man, and then have a white as
second husband; nevertheless, we have a fair number of recorded
instances of dark-colored children being born in the above way of white
parents.
"Dr. Harvey mentions a case in which 'a young woman, residing in
Edinburgh, and born of white (Scottish) parents, but whose mother, some
time previous to her marriage, had a natural (mulatto) child by a negro
man-servant in Edinburgh, exhibits distinct traces of the negro. Dr.
Simpson--afterward Sir James Simpson--whose patient the young woman at
one time was, has had no recent opportunities of satisfying himself as
to the precise extent to which the negro character prevails in her
features; but he recollects being struck with the resemblance, and
noticed particularly that the hair had the qualities characteristic of
the negro.' Herbert Spencer got a letter from a 'distinguished
correspondent' in the United States, who said that children by white
parents had been 'repeatedly' observed to show traces of black blood
when the women had had previous connection with (i.e., a child by) a
negro. Dr. Youmans of New York interviewed several medical professors,
who said
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