OF OBSTETRICS Gynecology and Pediatrics PUBLISHED BI-MONTHLY WM. FRANCIS HONAN, M. D., EDITOR VOL. XXIV. 1902 A. L. CHATTERTON & CO. 156 Fifth Ave., New York City JOURNAL OF OBSTETRICS, EDITOR, WM. FRANCIS HONAN, M. D., NOTE TO CONTRIBUTORS AND SUBSCRIBERS. 1. All articles or communications to this journal should be exclusively for its pages. 2. This Journal is published for its subscribers only, and has no free list. Sample copies are never sent. Subscriptions are not discontinued until so ordered. What is not right will always be made right cheerfully and without question. A. L. CHATTERTON & Co., Publishers, New York. Dr. H. C. Allen of this city asked me about the first of September last to see one of his patients, a woman thirty-one years of age, tall, well-proportioned, in splendid health, but who had never menstruated, with reference to ascertaining whether there existed any operable gynecological condition to account for her anomaly, in whom we were surprised to find a case of arrested development of the genitalia bearing peculiar interest, out of it growing a series of cases which are perhaps without parallel in gynecological literature. Ocular examination of this subject revealed a hairless mons veneris and pudendum, an entire absence of labia majora, rudimentary labia minora, only a tiny ostium vaginæ, and breasts which are rotund and perfect, except that there are neither nipples nor indications of a place where nipples ought to be. A little to the outer side of the glands, and below the usual location of nipples, are a few rudimentary glands of Montgom 132223 ery. But there is neither nipple, areola, nor anything like a normal aggregation of Montgomery's bodies, nor are they rightly located, such as there are. Digital examination revealed an infantile vagina, perhaps an inch and a half deep, terminating in a blind vault, with no semblance of a cervix uteri. Examination per rectum showed an absence of anything like a uterus, bimanual investigation supporting such absence. Nor was it possible to define broad ligaments or ovaries. This patient is a vigorous woman, gentle in disposition, possessed of the instincts of her sex, with feminine voice and absence of excessive hair on her face, there existing nothing superficial to in the slightest degree indicate that she is other than a normally developed and perfect specimen of womanhood. The clitoris is natural in size and location and responds quickly to touch. The patient confesses to a moderate sexual appetite, and while accepting the verdict sensibly rather bemoans her inability to meet advances from the opposite sex. She would like to get married "if right," but not if she is not like other women. ONE OF FOUR ABNORMAL SISTERS. This case, interesting in itself, is made especially so as the fact is developed that she is one of a family of five sisters, four of whom are physiological freaks. A sister two years older than she, i. e., thirty-three years of age, is reported by her to be like her in appearance of external genitalia, never to have menstruated, and to have no nipples. The sister who is here is unable, of course, to state what may be the condition within the pelvis, but is convinced it must be like herself, because all other indications are the same. She is an intelligent, truthful woman, with no reason for deception, hence we accept her report without hesitancy. A third sister, twenty-seven years of age, is like the ones of thirty-three and thirty-one, but there is a fourth sister, twenty-three years of age, whom we have seen, who is a perfect woman. Then comes the fourth freak daughter in the family, a girl of eighteen and a half, whose case is deserving of special description, and whom we now know to be wombless beyond the peradventure of doubt. A RARE GYNECOLOGICAL SUBJECT. This girl, Alma A., came under observation the first week in September, in wretched health. Her decline was associated with an impure vaccination in February. At that time her health was perfect, her weight 150 pounds. But she had never menstruated, though from time to time she had had a consciousness of pelvic fullness, weight, and sensitiveness, and had had for three years an irregularly recurring nosebleed, sometimes quite severe, this being followed by relief of, pelvic weight, etc. From excellent health in February she had declined into a condition quite deplorable. Her weight had decreased nearly forty pounds. She was having constantly recurring hectic fevers, with intense bodily heat, followed by debilitating sweats. Her temperature daily recorded 103 1-2°, her pulse varying from normal, or nearly so, in the morning to 140 in the afternoon, the elevation of temperature and increased pulserate lasting until well into the night. Coupled with these symptoms there were loss of appetite, great physical and mental debility, and a hopelessness amounting almost to despair. Her feet were swollen, her skin waxy, her eyes heavy. Respiration was pantingly rapid, but upon forced effort was good. The kidney and bowel functions were quite normal, except that the urine was heavily loaded with earthy phosphates, there was a trace of albumin, and the specific gravity was down to 1010. The elimination of urea was slightly deficient, but not enough to contraindicate surgical procedure. Examination revealed a counterpart of the older sister's condition of vulvar genitalia. No hair covered the mons or pudendum. The labia majora were absent, the minora underdeveloped. The clitoris was rather larger than normal and the os pubis was more acutely angled than in women. This girl's voice was rather heavy, but in no other particular did she seem at all masculine. In morale she was a child. The breasts were large and well-rounded, the nipples of normal |