Genetic Anomalies : Part 10

Anomalies and Curiosities of Medicine
by George M. Gould, M.D., Walter L. Pyle, M.D.

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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.