It is a safe general rule to consider every female from eight to eighty years of age either as pregnant or as possible of conceiving, even when other apparently impossible circumstances, aside from the question of age, may be present. Thus, the existence of an unruptured or apparently imperforate hymen will not necessarily exclude the possibility of gestation; nor will the positive affirmation of lack of penetration preclude conception. Sherwood-Dunn records the case of a woman from whom he removed both ovaries; subsequently she married and gave birth to a male child. Precocious Pregnancy.-By this term is meant the occurrence of gestation at an unusually tender age. Probably the earliest instance. of pregnancy is that famous case recorded by Tidy: A girl who had menstruated first at four years of age, conceived and was delivered of a living child when but eight years old. An allied case is recorded of a seven-pound baby being delivered from a mother but eight years and ten months old. Wharton and Stillé report an instance of a baby menstruating in her first year, and being delivered in her ninth year of a child weighing 7 pounds. Gleaves records the birth of a five-pound baby from a mother but ten years of age, and there are many instances recorded of girls of eleven to fourteen years giving birth to full-sized children. Wilkinson records the case of a negro girl who, when thirteen years, nine months, and five days old, gave birth to twins. Late Pregnancy.-Cases equally as interesting as the foregoing have been filed of women conceiving late in life, and being delivered of normal children. Thus, Halles records a labor occurring in a woman seventy years of age, and another in a woman of sixty-three years. Another physician records the birth of twins in a woman sixty-four years of age (Reese). It is not very uncommon to hear of women in the sixth decade giving birth to children. Hence, while the normal menopause occurs at from forty to forty-five years of age, this phenomenon may be indefinitely postponed, or ovulation may continue actively long after its associated phenomenon, menstruation, has ceased. Wolfe records an interesting case of a woman who menstruated for the first time when in her forty-third year, and continued to do so at irregular intervals until forty-five years of age, when she conceived and gave birth to a healthy child after a labor lasting but thirteen hours. Concealed Pregnancy.—It is a much more common occurrence for a young girl to endeavor to conceal the fact that she is pregnant than it is for her to feign pregnancy for purposes of extortion or of forcing a marriage. The English law imposes no obligation to make pregnancy known. In Scotland, however, should the pregnancy be concealed and the child be dead or missing, the woman is liable to prosecution on the charge of infanticide. The concealment of birth is a much more serious misdemeanor (see Concealed Birth, p. 85). Feigned Pregnancy.-It is rarely for purposes other than extortion or blackmail that a woman will pretend to be in gestation; hence such a claim merits the closest investigation to prevent the perpetration 1 Manuel complet de médecine légale. of an injustice. Almost invariably such women feign an advanced pregnancy that is, after the first trimester, and, fortunately, this is at a period when the true condition of affairs can generally be readily and positively recognized. It is easier, however, to prove the absence of a gestation than it is to prove that an existing distention of the abdomen is due to pregnancy. A refusal on the part of a woman to undergo a necessary examination will be safe grounds for declaring her imposition. Occasionally hysteric women may balloon the abdomen and produce curious movements of the abdominal muscles closely simulating the fetal motions. This constitutes a form of pseudocyesis that can be diagnosed by the administration of an anesthetic. IMPREGNATION DURING UNCONSCIOUSNESS. UNCONSCIOUS PREGNANCY. Here there are two closely allied and yet quite distinct propositions. The one indicates the occurrence of conception and early pregnancy in a woman, usually a married woman, without her entertaining any knowledge as to her true condition-unconscious pregnancy. The other is the occurrence in a woman, usually young and single, of gestation while the subject was in an unconscious condition, the result of deep sleep, coma, hysteria, hypnotism, or from the administration of an anesthetic. It must be recognized that intercourse during profound sleep (lethargy), either natural or the result of design, is quite possible. Such a condition will necessarily involve the question of rape. Under such circumstances it is not at all improbable for the woman to be unconscious of her delicate state during the first two or three months. After the fifth or sixth month, however, the continued menstrual suppression, together with the development of other diagnostic signs, should lead a woman with ordinary intellect to suspect her true condition. If she be a virgin, the soreness in and injuries to the vagina and vulva invariably associated with the first coitus should lead her to suspect violation immediately on a restoration to consciousness. Only in idiotic or feebleminded women is it possible to conceive of the unconscious carrying of a child to term, although several such cases are on record. An assumed unconsciousness is, however, quite a possible complicating factor. A woman may thus ascribe her symptoms to some pathologic growth, her labor-pains to intestinal colic, and, even when confronted by the child, deny knowledge as to the time and circumstances of its conception. Again, in rare cases of artificial impregnation of a woman by means of a syringe, conception may follow without the knowledge of the woman. When there exist motives for so pleading, the case requires the closest examination. In married women who have remained sterile for many years, or who conceive at or subsequent to the menopausal period, it is quite possible to conceive of a gestation advancing to near term without an accurate knowledge on their part of the actual state of affairs. Such women are much more prone to ascribe their condition to some pathologic affection (ovarian cystomata, ascites, uterine fibroid) than to gestation. An examination by a qualified obstetrician will readily reveal the true condition. Pregnancy in the Dead.-Occasionally, as for the purpose of identifying a woman or to prove her chastity, it will become necessary to make an autopsy to ascertain the condition of the genitalia. It must not be forgotten that in certain quarters there is a common practice of placing an unrelated fetus in the coffin of a woman in order to turn aside suspicion from the guilty person. The marks of gestation and delivery in the dead are to be found in the uterus, lower birth-canal, and in the ovary. An investigation of the uterine contents, even to a microscopic examination of the uterine scrapings, may become of positive value in certain cases. Owing to the excessive hypertrophy of the uterine muscles in gestation, decomposition will speedily take place in that organ after death, and it may be converted into a putrescent mass long before the other tissues yield. Quite the contrary is true of the unimpregnated uterus, and should an examination of such a body be made some months after death, the soft structures will be found well advanced in decomposition, with the exception of the uterus, which will probably be firm and resistant. This will be accepted as a positive proof of chastity. Should the woman have given birth to a child just prior to her death and the examination be made within a few days or weeks, the usual lesions in the vagina and cervix will be found, together with perineal and vulvar lacerations and contusions. The uterine contents that would indicate a pregnancy include an ovum, embryo, fetus, or fragments thereof; decidual and chorionic débris; bones, and moles. The earlier the examination is made, the more conclusive will be the proof; but if the embryo be advanced beyond the period of ossification, its bones may be recognized even though several years have elapsed since the maternal death. Microscopic examination of the uterine scrapings will reveal decidual cells and chorionic villi, both of which are diagnostic of pregnancy. Moles, also, if found, are proof positive of gestation. These include the placental or fleshy mole, and the uterine hydatids, or the vesicular or hydatidiform mole. The former is a thick, fleshy mass of tissue attached to the original placental site and consisting of both decidual and chorionic tissue, as shown by microscopic examination. It may include portions of an early ovum. Care must be taken not to confound such a growth with a uterine polypus, which generally consists of fibrous or muscular tissue suspended by a pedicle from some portion of the uterine wall, even as low as the cervical canal; it is not necessarily attached to the fundus, the common placental site. The ves‐ icular mole is comparatively common, and consists of a mass of grapelike tissue filling the entire uterine canal and at places penetrating the wall of the uterus, even causing perforation. A fatty mole is merely a fragment of retained placental tissue that has undergone fatty change. Partially organized blood-clots may also be found in the uterine cavity. All the foregoing may be advanced as valuable evidence of pregnancy. Other instances, not conclusive proof of gestation, which may be found postmortem in utero are true hydatids, which are exceedingly rare (not more than four or five such cases having been recorded), and the membranous formation that is shed in the rare condition known as membranous dysmenorrhea. Should any of the true products of gestation be found in the uterine cavity of a woman whose pregnancy could not have advanced beyond the third month, the indications would point to a criminal abortion, and spontaneous abortion in the first trimester is accompanied usually by the discharge of an intact ovum. An ovary of a dead woman may show a recent scar, or corpus luteum, following the discharge of an ovum from a Graafian follicle. Formerly it was believed that a difference existed in the corpus luteum following an unfruitful ovulation and that associated with pregnancy. The latter was believed to be much larger in size and deeper in color. Hence arose the terms true and false corpus luteum, the former being the corpus luteum of pregnancy. It is now recognized that no diagnostic significance can be attached to the scar of ovulation. Pregnancy can occur without an appreciable corpus luteum being found, and a so-called true corpus luteum may accompany ovulation occurring during the growth of a uterine fibroid or any other condition, inflammatory or non-inflammatory, resulting in marked pelvic congestion, of which condition alone it is indicative, irrespective of the cause. LEGITIMACY.-THE DETERMINATION OF SEX. SIGNS OF DELIVERY.' LEGITIMACY. Legitimacy is defined as "the state of being born in lawful marriage." The question of legitimacy from the medicolegal point of view embraces the subjects of disputed chastity, the duration of pregnancy, viability of the child, the physical incapacity of husband or wife, child-substitution, superfetation, and posthumous birth. In order to arrive at a definite conclusion in a given case medical and moral evidence, either alone or combined, may be employed. The question of illicit intercourse, with possible subsequent conception, while bearing indirectly upon the subject, is not to be included here. It is presumed that any person born during the continuance of a lawful marriage between the mother and any man, or within a competent time after the dissolution of such marriage, is legitimate.3 A child may, however, be shown to be illegitimate when it is possible to demonstrate that the man claimed to be the husband is practically incapable of being the father, as-(1) when he is under the age of puberty; (2) when he exhibits some physical incapacity, as extreme age, or some natural infirmity, as azoospermism; (3) when he was out of the country at the time the child was begotten, or a considerable length of time had elapsed since coitus had occurred, or from absence from home or death of the husband (4) where the impossibility is based on the laws of nature-that is, a white child is born of black parents, or vice versa. The date of the birth is the time that receives special consideration, since it is a fixed time; the date of conception cannot accurately be determined, even when there has occurred but a single intercourse the date of which is known; conception in such a case may not follow for many days, during which time the spermatozoids retain their vitality in the female generative tract. Again, the child will be pronounced illegitimate if adultery on the part of the woman can be proved and the offspring is repudiated by the husband. 1 Grateful acknowledgment is due John C. Hinckley, Esq., of Philadelphia, for information on all legal questions touched upon in this chapter. Rawle's Bourier's Law Dictionary, p. 183. Greenleaf-Lewis's edition, Philadelphia, 1896, sections 28 and 150; Chase's Stephen on Evidence, p. 255, second American edition, 1898. King es. Luffe, 8 East 207, 1807. › American and English Encyclopedia of Law, first edition, p. 225. * Whisterlos's case in Cross vs. Cross, Paige Ch. New York, 139. |