Unconscious Pregnancy, Pseudocyesis

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

(Page 9 of 39)

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."