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.

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