PREMATURE UTERINE DEVELOPMENT.
Not only the uterus, but the other internal and external genitals and the breasts, may have during childhood the size and shape proper only to maturer years. The general system may or may not correspond to the anomalous development.
Sometimes excessive growth begins to manifest itself immediately after birth. The mental development may be excessive, normal, or deficient.
The hyperplasia of the uterus has been but very seldom demonstrated directly, on account of the difficulties in the way of an internal examina tion in children.
It is remarkable that no one has attempted to make a rectal examina tion in menstruatio prwcox.
We conclude that the anomaly exists from certain symptoms, especially menstruatio prtecox. But the symptoms may lead us into error. Pre mature growth of the entire body by no means necessarily means excess ive growth of the womb. Even excessive growth of the external genitala does not prove it; for Cooke has seen an autopsy on a girl four years old, whose external genitals were those of puberty, yet whose uterus and ova ries were childlike. Nor must genital hemorrhages, especially when not quite regular, be immediately received as menses. That is only the case when they are regular, last several days, and no other disease is present. We can only attain certainty by local examination, an autopsy, or preg nancy. No local examination seems yet to have been made, and there have been but very few autopsies that are reliable. Thus Campbell men tions a case in which a girl menstruated from birth every three weeks. She died at four years; and the autopsy showed that the sexual organs were unusually developed. Prochownik has recently reported the follow ing very interesting case: A very rachitie and scrofulous child had had regular hemorrhages every four weeks, lasting two to three days, since its first year. Two days after cessation of a hemorrhage the child died of miliary tuberculosis. The autopsy showed a normal and proper general development; the breasts were moderately and the external genitals more strongly devel oped and hairy. The uterus was that of a child approaching puberty, not one three years old. The internal -surface of the organ looked as if menstruation had just ceased from it'. The ovaries were infantile in size, but as large as those of a ten year old girl. The follicles were de veloped, a corpus luteum and scars were present; they undoubtedly lune tionated as in the adult.
Pregnancy is a still better proof. The ripening of follicles, concep
tion, and the reception and growth of the ovum demand adult organs. Such cases have been observed, though but rarely. I will mention one very reliable case from among the older records.
Anna Mummenthaler died at Trachselwald in Berne on the 11th of January 1816, seventy-five years old. Even at birth she was excessively developed; at her second year she menstruated regularly, and continued to do so till fifty-two years old. When eight years old her uncle impreg nated her, and fled. Nine months later she was instrumentally delivered by Dr. Brown. The child was dead, and was an ell long. She ceased growing after her eighth year. All these things are well known, and are proven.' Dr. Rowlett of Kentucky reports a case of puberty and pregnancy in a girl of ten; and H. Bodd a girl who menstruated irregularly after her first, and regularly after her seventh year, and who had a child at eight years and ten and a half months.
Sally Deveese was born on April 7th, 1824. She was of normal size. But a few weeks after birth her hips and breasts began to grow rapidly. In her twelfth month menses appeared, and her hips and breasts were so large as to excite universal attention. In 1833 she became pregnant, and on April 20th, 1834, was delivered of a healthy girl weighing seven and three quarter pounds. Thus at the age of ten years and thirteen days, she became the mother of a child of ordinary size. It refused the breast, and had to be raised on the bottle. It was healthy. The mother was four feet seven inches high, and weighed one hundred pounds; her appearance and understanding is tbat of a girl of her age. She was the fifteenth child of her mother, who bore her at forty-five years. No other such case has occurred on either side of her family.
More recently (1878) Molitor has reported a case of maturity at eight years.
Child was born with hair on the pubis. At fourth year the periods appeared regularly, and the entire body developed as at puberty. At eight years and three months she became pregnant; and at the fifth month gave birth to a fcetus corresponding in size to the third. month of pregnancy.
Hence it seems that the facultas gestandi and the facultas concipiendi do not always coincide.
We know nothing certain as to the real origin of premature sexual development. High grade of maternal productivity and dyscrasic diseases in the children have been cited, but in most cases there is no basis for any theory whatsoever.