The early historical roots of pediatric and adolescent gynecology.

BACKGROUND: The science of medicine is a constantly evolving process that builds on the experiences and observations of the past. We hypothesized that the issues of pediatric and adolescent gynecology were also of concern to physicians practicing in the 19th century. We sought to determine the extent to which our forebears of over 100 years ago considered, diagnosed, and treated these problems. METHODS: We conducted an exhaustive search through two English-language medical journals, The Obstetrical Journal of Great Britain and Ireland (vol. 1-7, 1873-1880) and The American Journal of Obstetrics (vol. 1-32, 1869-1895), for articles relating to pediatric and adolescent gynecology. RESULTS: The most frequently encountered subject was the surgical management of congenital absence or atresia of the vagina and associated anomalies of adjacent organs. By 1881, the opinion expressed by many investigators was that the method used by Thomas Addis Emmet to create an artificial vagina between the bladder and the rectum by a single-stage procedure of blunt dissection and the immediate placement of a glass vaginal dilator gave the best chance of a favorable outcome. The practice of making an artificial opening through the rectum was abandoned. In 1882, a review of published reports noted 43% postoperative mortality in children treated for benign and malignant ovarian tumors. A review article in 1891 reported a 10% mortality rate associated with treatment of the imperforate hymen. A research article in 1870 noted the mean age at menarche in England to be 14.96 years. Additional subjects in the literature included: "Acquired Venereal Disease in Children" warning of the need for "rigid ... scrutiny of the attendants and playmates of children" (1893), the enigmatic occurrence of "Vaginal Hemorrhage in an Infant Five-Days-Old" (1874), the brutal atrocities perpetrated against "The Child Wives of India" (1895), "Early Pregnancy" reviewing childbirth by young adolescents (1874), "Hermaphrodism" (1886), "The ... Hymen and Its Remains ..." (1871), a "Case of Fatal Hemorrhage from the Genital Organs" in which a 17-year-old exsanguinated from a vaginal laceration (1879), and "Primary Sarcoma of the Vagina ... in a Child Three-Years-Old" (1881). CONCLUSION: Modern pediatric and adolescent gynecology can trace its roots to well over a century ago.

The stilbestrol disorders in historical perspective.

In the late 1960's when a series of adolescent girls with adenocarcinoma of the vagina presented themselves to our hospital, we did not immediately suspect the cause. Previous experience with radical hysterectomy and with vaginal reconstruction had prepared us technically to treat them sucessfully. Then a clue to etiology from one mother's observation regarding DES as a pregnancy supportive medication was quickly and conclusively converted into fact by an investigation with case controls. Rapid expansion of our knowledge came about through information accumulated in a Registry, and untoward effects other than cancer soon came to notice as young asymptomatic women presented themselves for examination because of known fetal exposure. The dominant event is clearly recognizable ss teratogenic, resulting in anomalous development of the vagina and cervix. Although the appearance of clear cell adenocarcinoma in a small fraction of DES-daughters is a consequence, the role of DES in its carcinogenesis is still unproved.

An ancient report of a dermoid cyst of the vagina.

There is a degree of imprecision in translating the Talmud from its original language into English. It is unlikely that we will ever know with certainty what a wart meant to the ancients. That this Talmudic reference represents the first description of a vaginal dermoid is a distinct possibility.