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, 3cases; 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.
