[Reprinted from The Medical News, September 30, 1893.] 
IMPERFORATE HYMEN, WITH RETENTION OF 
MENSTRUAL FLUID. 
By ADOLPH KAHN, Ph.G., M.D., 
OF SAN FRANCISCO, CAL. 
On the evening of July 4th, at 10 o’clock, I received a 
summons to attend Miss R. A., who, the messenger in- 
formed me, was suffering great pain in the abdomen, and 
also that something was protruding from her parts. 
The patient, a well-nourished and vigorous girl of nine- 
teen years, I was informed, had, about four weeks previ- 
ously, a similar, yet not quite as severe an attack as the 
present one, for which she consulted a physician. The 
affection was pronounced ‘‘bowel-complaint,” and the 
girl was ordered the “rest-cure” for one week, as she 
termed it—remaining in a recumbent position, subsisting 
on a diet of milk, rice, and toasted bread, with a table- 
spoonful of castor-oil each night. In a few days she felt 
comparatively free from pain, but the uneasiness in the 
abdomen and bladder still persisted, with frequent stools 
and painful micturition. On the 2d of July the abdomi- 
nal pains returned, increasing continually, and while at 
stool she became aware of the protrusion from her body. 
It was then deemed advisable on the part of the relatives 
to call a physician. 
Upon examination, I discovered an abdominal tumor 
extending upward to the umbilicus, giving the girl an 
appearance of being about six months pregnant, and 
causing me to inquire when she had last menstruated. 
In reply, I was informed that she had never menstruated, 
ard that late menstruation was a family feature. I then 2 
proposed to ascertain the nature of the protrusion, and 
found the anus in a normal condition. I endeavored to 
make a vaginal examination, but that was impossible, for 
the hymen proved to be imperforate, the membrane 
being distended and protruding, the labia separated to 
an extent of two inches, and the perineum bulging as if 
pressed upon by a fetal head. 
The parents were informed of the nature of the con- 
dition, and that an operation would be necessary. For 
the night, the pains were calmed by an anodyne sup- 
pository. On the following day, at my request, Dr. C. 
E. von Hoffman saw the case with me. The membrane 
was anesthetized with cocain, and a small incision was 
made in the median line, giving exit to a dirty-brown 
fluid, of which about two quarts escaped, when it became 
semi-gelatinous, necessitating the removal of a piece of 
membrane to permit it to flow more freely, but it gradu- 
ally became so gelatinous that it had to be carefully 
pulled out with forceps. At least two more quarts were 
removed by this process. 
The operation was performed upon strictly aseptic 
principles. There was no subsequent elevation of tem- 
perature. The patient was kept in bed for a week. 
The points of interest in this case are : The condition 
of the menstrual fluid evacuated, the gelatinous sub- 
stance showing that absorption must have taken place ; 
the rapid recovery of the patient, showing the small 
danger attendant upon the rapid evacuation of accu- 
mulations under strict aseptic procedure ; and the mis- 
taken diagnosis in the first place; also, the extreme thick- 
ness of the membrane—one-eighth of an inch at least, 
when distended. 
The patient has since had a normal menstrual period. 
430 Kearny Street.