 | CHAPTER II.
PRENATAL ANOMALIES. Anomalies and Curiosities of Medicine |  |
2. CHAPTER II.
PRENATAL ANOMALIES.
Extrauterine Pregnancy.—In the consideration of prenatal anomalies, the first to be discussed will be those of extrauterine pregnancy. This abnormalism has been known almost as long as there has been any real knowledge of obstetrics. In the writings of Albucasis, *[115] during the eleventh century, extrauterine pregnancy is discussed, and later the works of N. Polinus and Cordteus, about the sixteenth century, speak of it; in the case of Cordseus the fetus was converted into a lithopedion and carried in the abdomen twenty-eight years. Horstius in the sixteenth century relates the history of a woman who conceived for the third time in March, 1547, and in 1563 the remains of the fetus were still in the abdomen.
Israel Spach, in an extensive gynecologic work published in 1557, figures a lithopedion drawn in situ in the case of a woman with her belly laid open. He dedicated to this calcified fetus, which he regarded as a reversion, the following curious epigram, in allusion to the classical myth that after the flood the world was repopulated by the two survivors, Deucalion and Pyrrha, who walked over the earth and cast stones behind them, which, on striking the ground, became people. Roughly translated from the Latin, this epigram read as follows: "Deucalion cast stones behind him and thus fashioned our tender race from the hard marble. How comes it that nowadays, by a reversal of things, the tender body of a little babe has limbs nearer akin to stone?'' [2.1] Many of the older writers mention this form of fetation as a curiosity, but offer no explanation as to its cause. Mauriceau *[513] and de Graaf *[384] discuss in full extrauterine pregnancy, and Salmuth, Hannseus, and Bartholinus describe it. From the beginning of the eighteenth century this subject always demanded the attention and interest of medical observers. In more modern times, Campbell and Geoffroy-Saint-Hilaire, who named it "Grossesse Pathologique,'' have carefully defined and classified the forms, and to-day every text-book on obstetrics gives a scientific discussion and classification of the different forms of extrauterine pregnancy.
The site of the conception is generally the wall of the uterus, the Fallopian tube, or the ovary, although there are instances of pregnancy in the vagina, as for example when there is scirrhus of the uterus; [2.2] and again, cases
In most cases there is rupture of the fetal sac into the abdominal cavity or the uterus, and the fetus is ejected into this location, from thence to be removed or carried therein many years; but there are instances in which the conception has been found in situ, as depicted in Figure 2. A sturdy woman [2.4] of thirty was executed on January 16, 1735, for the murder of her child. It was ascertained that she had passed her catamenia about the first of the month, and thereafter had sexual intercourse with one of her fellow-prisoners. On dissection both Fallopian tubes were found distended, and the left ovary, which bore signs of conception, was twice as large as the right. Campbell *[248] quotes another such case in a woman of thirty-eight who for twenty years had practised her vocation as a Cyprian, and who unexpectedly conceived. At the third month of pregnancy a hard extrauterine tumor was found, which was gradually increasing in size and extending to the left side of the hypogastrium, the associate symptoms of pregnancy, sense of pressure, pain, tormina, and dysuria, being unusually severe. There was subsequently at attack of inflammatory fever, followed by tumefaction of the abdomen, convulsions, and death on the ninth day. The fetus had been contained in the peritoneal coat of the ovary until the fourth month, when one of the feet passed through the cyst and caused the fatal result. Signs of acute peritonitis were seen postmortem, the abdominal cavity was full of blood, and the ovary much lacerated.
The termination of extrauterine pregnancy varies; in some cases the fetus is extracted by operation after rupture; in others the fetus has been delivered alive by abdominal section; it may be partially absorbed, or carried many years in the abdomen; or it may ulcerate through the confining walls, enter the bowels or bladder, and the remnants of the fetal body be discharged.
The curious cases mentioned by older writers, and called abortion by the mouth, etc., are doubtless, in many instances, remnants of extrauterine pregnancies or dermoid cysts. Maroldus *[507] speaks in full of such cases; Bartholinus, Salmuth, [2.5] and a Reyes [2.6] speak of women vomiting remnants of fetuses. In Germany, [2.7] in the seventeenth century, there lived a woman who on three different occasions is said to have vomited a fetus. The last miscarriage in this manner was of eight months' growth and was accompanied
by its placenta. The older observers thought this woman must have had two orifices to her womb, one of which had some connection with the stomach, as they had records of the dissection of a female in whom was found a conformation similar to this.
Discharge of the fetal bones or even the whole of an extrauterine fetus by the rectum is not uncommon. There are two early cases mentioned [2.8] in
Bartholinus *[190] and Rosseus *[692] speak of fetal bones being discharged from the urinary passages. Ebersbach, in the Ephemerides of 1717, describes a necropsy in which a human fetus was found contained in the bladder. In 1878 White [2.18] reported an instance of the discharge of fetal remains through the bladder.
Discharge of the Fetus through the Abdominal Walls.—Margaret Parry of Berkshire [2.19] in 1668 voided the bones of a fetus through the flesh above the os pubis, and in 1684 she was alive and well, having had healthy children afterward. Brodie [2.20] reports the history of a case in a negress who voided a fetus from an abscess at the navel about the seventeenth month of conception. Modern instances of the discharge of the extrauterine fetus from the walls of the abdomen are frequently reported. Algora [2.21] speaks of an abdominal pregnancy in which there was spontaneous perforation of the anterior abdominal parietes, followed by death. Bouzal [2.22] cites an extraordinary case of ectopic gestation in which there was natural expulsion of the fetus through abdominal walls, with subsequent intestinal strangulation. An artificial anus was established and the mother recovered. Brodie, Dunglison, Erich, Rodbard, Fox, and Wilson are among others reporting the expulsion of remnants of ectopic pregnancies through the abdominal parietes. Campbell quotes the case of a Polish woman, aged thirty-five, [2.23] the mother of nine
Bodinier [2.26] and Lusk [2.27] report instances of the delivery of an extrauterine fetus by the vagina; and Mathieson [2.28] relates the history of the delivery of a living ectopic child by the vagina, with recovery of the mother. Gordon [2.29] speaks of a curious case in a negress, six months pregnant, in which an extrauterine fetus passed down from the posterior culdesac and occluded the uterus. It was removed through the vagina, and two days later labor-pains set in, and in two hours she was delivered of a uterine child. The placenta was left behind and drainage established through the vagina, and the woman made complete recovery.
Combined Intrauterine and Extrauterine Gestation.—Many well-authenticated cases of combined pregnancy, in which one of the products of
and being pregnant was opened. In the right iliac fossa was found a male child weighing 5 pounds and 5 ounces, 8 1/2 inches long, and of about five months' growth. The uterus also contained a male fetus of about three months' gestation. Figure 4 shows combined intrauterine and extrauterine gestation. Hodgen [2.35] speaks of a woman of twenty-seven, who was regular until November, 1872; early in January, 1873, she had an attack of pain with peritonitis, shortly after which what was apparently an extrauterine pregnancy gradually diminished. On August 17, 1873, after a labor of eight hours, she gave birth to a healthy fetus. The hand in the uterus detected a tumor to the left, which wag reduced to about one-fourth the former size. In April, 1874, the woman still suffered pain and tenderness
with severe pain which continued a week and then ceased. Health soon improved, and the woman afterward gave birth to a third child; subsequently she noticed that the tumor had enlarged since the first birth, and she had a recurrence of pain and a slight hemorrhage every three weeks, and distinctly felt motion in the tumor. This continued for eighteen months, when, after a most violent attack of pain, all movement ceased, and, as she expressed it, she knew the moment the child died. The tumor lost its natural consistence and felt flabby and dead. An incision was made through the linea alba, and the knife came in contact with a hard, gritty substance, three or four lines thick. The escape of several quarts of dark brown fluid followed the incision, and the operation had to be discontinued on account of the ensuing syncope. About six weeks afterward a bone presented at the orifice, which the woman extracted, and this was soon followed by a mass of bones, hair, and putrid matter. The discharge was small, and gradually grew less in quantity and offensiveness,
Ahlfeld, Ambrosioni, Galabin, Packard, Thiernesse, Maxson, de Belamizaran, Dibot, and Chabert are among others recording the phenomenon of coexisting extrauterine and intrauterine pregnancy. Argles [2.39] mentions simultaneous extrauterine fetation and superfetation.
Sanger [2.40] mentions a triple ectopic gestation, in which there was twin pregnancy in the wall of the uterus and a third ovum at the fimbriated end of the right tube. Careful examination showed this to be a case of intramural twin pregnancy at the point of entrance of the tube and the uterus, while at the abdominal end of the same tube there was another ovum,—the whole being an example of triple unilateral ectopic gestation.
The instances of delivery of an extrauterine fetus, with viability of the child, from the abdomen of the mother would attract attention from their rarity alone, but when coupled with associations of additional interest they surely deserve a place in a work of this nature. Osiander *[615] speaks of an abdominal fetus being taken out alive, and there is a similar case on record in the early part of this century. [2.41] The London Medical and Physical Journal, in one of its early numbers, contained an account of an abdominal fetus penetrating the walls of the bladder and being extracted from the walls of the hypogastrium; but Sennertus gives a case which far eclipses this, both mother and fetus surviving. He says that in this case the woman, while pregnant, received a blow on the lower part of her body, in consequence of which a small tumor appeared shortly after the accident. It so happened in this case that the peritoneum was extremely dilatable, and the uterus, with the child inside, made its way into the peritoneal sac. In his presence an incision was made and the fetus taken out alive. Jessop [2.42] gives an example of extrauterine gestation in a woman of twenty-six, who had previously had normal delivery. In this case an incision was made and a fetus of about eight months' growth was found lying loose in the abdominal cavity in the midst of the intestines. Both the mother and child were saved. This is a very rare result. Campbell, in his celebrated monograph, in a total of 51 operations had only seen recorded the accounts of two children saved, and one of these was too marvelous to believe. Lawson Tait reports a case in which he saved the child, but lost the mother on the fourth day. Parvin describes a case in which death occurred on the third day. Browne [2.43] quotes Parry as saying that there is one twin pregnancy in 23 extrauterine conceptions. He gives 24 cases of twin conception, one of which was uterine, the other extrauterine, and says that of 7 in the third month, with no operation, the mother died in 5. Of 6 cases of from four and a half to seven months' duration, 2 lived, and in 1 case at the fifth month there was an
The British Medical Journal quotes: "Pinard (Bull. de l'Acad. de Méd., August 6, 1895) records the following, which he describes as an ideal case. The patient was aged thirty-six, had had no illness, and had been regular from the age of fourteen till July, 1894. During August of that year she had nausea and vomiting; on the 22d and 23d she lost a fluid, which was just pink. The symptoms continued during September, on the 22d and 23d of which month there was a similar loss. In October she was kept in bed for two days by abdominal pain, which reappeared in November, and was then associated with pain in micturition and defecation. From that time till February 26, 1895, when she came under Pinard's care, she was attended by several doctors, each of whom adopted a different
Statistics of Successful Operations
[Description: Table of operations]
Statistics of Successful Operations
[Description: Table of operations]
Quite recently Werder [2.47] has investigated the question of the ultimate fate of ectopic children delivered alive. He has been able to obtain the record of 40 cases. Of these, 18 died within a week after birth; 5 within a month; 1 died at six months of bronchopneumonia; 1 at seven months of diarrhea; 2 at eleven months, 1 from croup; 1 at eighteen months from cholera infantum—making a total of 26 deaths and leaving 14 children to be accounted for. Of these, 5 were reported as living and well after operation, with no subsequent report; 1 was strong and healthy after three weeks, but there has been no report since; 1 was well at six months, then was lost sight of; 1 was well at the Last report; 2 live and are well at one year; 2 are living and well at two years; 1 (Beisone's case) is well at seven years; and 1 (Tait's case) is well at fourteen and one-half years. The list given on pages 60 and 61 has been quoted by Hirst and Dorland. [2.48] It contains data relative to 17 cases in which abdominal section has been successfully performed for advanced ectopic gestation with living children.
Long Retention of Extrauterine Pregnancy.—The time of the retention of an extrauterine gestation is sometimes remarkable, and it is no uncommon occurrence for several pregnancies to successfully ensue during such retention. The Ephemerides contains examples of extrauterine pregnancy remaining in the abdomen forty-six years; [2.49] Hannæus [2.50] mentioned an instance remaining ten years, the mother being pregnant in the meantime; Primperosius speaks of a similar instance; de Blegny, [2.51] one of twenty-five years in the abdomen; Birch, a case of eighteen years in the abdomen, the woman bearing in the meantime; Bayle, [2.52] one of twenty-six years, and the Ephemerides, another. In a woman of forty-six, [2.53] the labor pains intervened without expulsion of the fetus. Impregnation ensued twice afterward, each followed by the birth of a living child. The woman lived to be ninety-four, and was persuaded that the fetus was still in the abdomen, and directed a postmortem examination to be made after her decease, which was done, and a large cyst containing an ossified fetus was discovered in the left side of the cavity. In 1716 [2.54] a woman of Joigny when thirty years old, having been married four years, became pregnant, and three months later felt movements and found milk in her breasts. At the ninth month she had labor-pains, but the fetus failed to present; the pains ceased, but recurred in a month, still with a negative result. She fell into a most sickly condition and remained so for eighteen months, when the pains returned again, but soon ceased. Menstruation ceased and the milk in her breasts remained for thirty years. She died at sixty-one of peripneumonia, and on postmortem examination a tumor was found occupying part of the hypogastric and umbilical regions. It weighed eight pounds and consisted of a male
Cordier [2.56] publishes a paper on ectopic gestation, with particular reference to tubal pregnancy, and mentions that when there is rupture between the broad ligaments hemorrhage is greatly limited by the resistance of the surrounding structures, death rarely resulting from the primary rupture in this location. Cordier gives an instance in which he successfully removed a full-grown child, the result of an ectopic gestation which had ruptured intraligamentally and had been retained nearly two years.
Lospichlerus [2.57] gives an account of a mother carrying twins, extrauterine, for six years. Mounsey of Riga, physician to the army of the Czarina, sent to the Royal Society in 1748 the bones of a fetus that had been extracted from one of the fallopian tubes after a lodgment of thirteen years. Starkey Middleton [2.58] read the report of a case of a child which had been taken out of the abdomen, having lain there nearly sixteen years, during which time the mother had borne four children. It was argued at this time that boys were conceived on the right side and girls on the left, and in commenting on this Middleton remarks that in this case the woman had three boys and one girl after the right fallopian tube had lost its function. Chester [2.59] cites the instance of a fetus being retained fifty-two years, the mother not dying until her eightieth year. Margaret Mathew [2.60] carried a child weighing eight pounds in her abdomen for twenty-six years, and which after death was extracted. Aubrey [2.61] speaks of a woman aged seventy years unconsciously carrying an extrauterine fetus for many years, which was only discovered postmortem. She had ceased to menstruate at forty and had borne a child at twenty-seven. Watkins [2.62] speaks of a fetus being retained forty-three years; James, others for twenty-five, thirty, forty-six, and fifty years; Murfee, [2.63] fifty-five years; Cunningham, [2.64] forty years; Johnson, [2.65] forty-four years; Josephi, [2.66] fifteen years (in the urinary bladder); Craddock, [2.67] twenty-two years, and da Costa Simões, [2.68] twenty-six years.
Long Retention of Uterine Pregnancy.—Cases of long retained intrauterine pregnancies are on record and deserve as much consideration as those that were extrauterine. Albosius speaks of a mother carrying a child in an ossified condition in the uterus for twenty-eight years. [2.69] Cheselden speaks
Buchner [2.74] speaks of a fetus being retained in the uterus for six years, and Horstius [423] relates a similar case. Schmidt's Jahrbücher [2.75] contain the report of a woman of forty-nine, who had borne two children. While threshing corn she felt violent pain like that of labor, and after an illness suffered a constant fetid discharge from the vagina for eleven years, fetal bones being discharged with occasional pain. This poor creature worked along for eleven years, at the end of which time she was forced to bed, and died of symptoms of purulent peritonitis. At the necropsy the uterus was found adherent to the anterior wall of the abdomen and containing remnants of a putrid fetus with its numerous bones. There is an instance recorded [2.76] of the death of a fetus occurring near term, its retention and subsequent discharge being through a spontaneous opening in the abdominal wall one or two months after.
Meigs [2.77] cites the case of a woman who dated her pregnancy from March, 1848, and which proceeded normally for nine months, but no labor supervened at this time and the menses reappeared. In March, 1849, she passed a few fetal bones by the rectum, and in May, 1855, she died. At the necropsy the uterus was found to contain the remains of a fully developed fetus, minus the portions discharged through a fistulous connection between the uterine cavity and the rectum. In this case there had been retention of a fully developed fetus for nine years. Cox [2.78] describes the case of a woman who was pregnant seven months, and who was seized with convulsions; the supposed labor-pains passed off, and after death the fetus was found in the womb, having lain there for five years. She had an early return of the menses, and these recurred regularly for four years. Dewees *[419] quotes two cases, in one of which the child was carried twenty months in the uterus; in the other, the mother was still living two years and five months after fecundation. Another case [2.79] was in a woman of sixty, who had conceived at twenty-six, and whose fetus was found, partly ossified, in the uterus after death.
There are many narratives of the long continuation of fetal movements, and during recent years, in the Southern States, there was quite a
The extraordinary diversity of reports concerning the duration of pregnancy has made this a much mooted question. Many opinions relative to the longest and shortest period of pregnancy, associated with viability of the issue, have been expressed by authors on medical jurisprudence. There is perhaps no information more unsatisfactory or uncertain. Mistakes are so easily made in the date of the occurrence of pregnancy, or in the date of conception, that in the remarkable cases we can hardly accept the propositions as worthy evidence unless associated with other and more convincing facts, such as the appearance and stage of development of the fetus, or circumstances making conception impossible before or after the time mentioned, etc. It will be our endeavor to cite the more seemingly reliable instances of the anomalies of the time or duration of pregnancy reported in reputable periodicals or books.
Short Pregnancies.—Hasenet [2.80] speaks of the possibility of a living birth at four months; Capuron relates the instance of Fortunio Liceti, who was said to have been born at the end of four and a half months and lived to complete his twenty-fourth year. In the case of the Marechal de Richelieu, the Parliament of Paris decreed that an infant of five months possessed that capability of living the ordinary period of existence, i. e., the "viabilité,'' which the law of France requires for the establishment of inheritance. In his seventh book Pliny gives examples of men who were born out of time. Jonston [2.81] gives instances of births at five, six, seven, and eight months. Bonnar [2.82] quotes 5 living births before the one hundred and fiftieth day; 1 of one hundred and twenty-five days; 1 of one hundred and twenty days; 1 of one hundred and thirty-three days, surviving to twenty-one months; and 1 of one hundred and thirty-five days' pregnancy surviving to eighty years. Maisonneuve *[462] describes a case in which abortion took place at four and a half months; he found the fetus in its membranes two hours after delivery, and, on laying the membranes open, saw that it was living. He applied warmth, and partly succeeded in restoring it; for a few minutes respiratory movements were performed regularly, but it died in six hours. Taylor *[757] quotes Carter concerning the case of a fetus of five months which cried directly after it was born, and in the half hour it lived it tried frequently to breathe. He also quotes Davies,
Ruttel speaks of a child of five months who lived twenty-four hours; and he saw male twins born at the sixth month weighing 3 pounds each who were alive and healthy a year after. Barker [2.85] cites the case of a female child born on the one hundred and fifty-eighth day that weighed 1 pound and was 11 inches long. It had rudimentary nails, very little hair on the head, its eyelids were closed, and the skin much shriveled; it did not suckle properly, and did not walk until nineteen months old. Three and a half years after, the child was healthy and thriving, but weighed only 29 1/2 pounds. At the time of birth it was wrapped up in a box and placed before the fire. Brouzet speaks of living births of from five to six months' pregnancy, and Kopp [2.86] speaks of a six months' child which lived four days. The Ephemerides contains accounts of living premature births.
Newinton describes a pregnancy of five months terminating with the birth of twins, one of whom lived twenty minutes and the other fifteen. The first was 11 1/2 inches long, and weighed 1 pound 3 1/2 ounces, and the other was 11 inches long, and weighed 1 pound. There is a recent instance of premature birth [2.87] following a pregnancy of between five and a half and six months, the infant weighing 955 grams. One month after birth, through the good offices of the wet-nurse and M. Villemin, who attended the child and who invented a "couveuse'' for the occasion, it measured 38 cm. long.
Moore [2.88] is accredited with the trustworthy report of the case of a woman who bore a child at the end of the fifth month weighing 1 1/2 pounds and measuring 9 inches. It was first nourished by dropping liquid food into its mouth; and at the age of fifteen months it was healthy and weighed 18
Villemin [2.90] before the Société Obstetricale et Gynécologique reported the case of a two-year-old child, born in the sixth month of pregnancy. That the child had not had six months of intrauterine life he could vouch, the statement being borne out by the last menstrual period of the mother, the date of the first fetal movements, the child's weight, which was 30 1/2 ounces, and its appearance. Budin had had this infant under observation from the beginning and corroborated Villemin's statements. He had examined infants of six or seven months that had cried and lived a few days, and had found the alveolar cavities filled with epithelial cells, the lung sinking when placed in a vessel of water. Charpentier reported a case of premature birth in his practice, the child being not more than six and a half months and weighing 33 1/2 ounces. So sure was he that it would not live that he placed it in a basin while he attended to the mother. After this had been done, the child being still alive, he wrapped it in cotton and was surprised next day to find it alive. It was then placed in a small, well-heated room and fed with a spoon on human milk; on the twelfth day it could take the breast, since which time it thrived and grew.
There is a case on record [2.91] of a child viable at six months and twenty days. The mother had a miscarriage at the beginning of 1877, after which menstruation became regular, appearing last from July 3 to 9, 1877. On January 28, 1878, she gave birth to a male infant, which was wrapped in wadding and kept at an artificial temperature. Being unable to suckle, it was fed first on diluted cow's milk. It was so small at birth that the father passed his ring over the foot almost to the knee. On the thirteenth day it weighed 1250 grams, and at the end of a week it was taking the breast. In December, 1879, it had 16 teeth, weighed 10 kilograms, walked with agility, could pronounce some words, and was especially intelligent. Capuron *[254] relates an instance of a child born after a pregnancy of six and a half months and in excellent health at two years, and another living at ten years of the same age at birth. Tait [2.92] speaks of a living female child, born on the one hundred and seventy-ninth day, with no nails on its fingers or toes, no hair, the extremities imperfectly developed, and the skin florid and thin. It
In some cases there seems to be a peculiarity in women which manifests itself by regular premature births. La Motte, van Swieten, and Fordere mention females who always brought forth their conceptions at the seventh month.
The incubator seems destined to be the future means of preserving these premature births. Several successful cases have been noticed, and by means of an incubator Tarnier succeeded in raising infants which at the age of six months were above the average. A full description of the incubator may be found. [2.95] The modified Auvard incubator is easily made; the accompanying illustrations (Figs. 5, 6, and 7) explain its mechanism. Several improved incubators have been described in recent years, but the Auvard appears to be the most satisfactory.
The question of retardation of labor, like that of premature birth, is open to much discussion, and authorities differ as to the limit of protraction with viability. Aulus Gellius [2.96] says that, after a long conversation with the physicians and wise men, the Emperor Adrian decided in a case before him, that of a woman of chaste manners and irreproachable character, the child born eleven months after her husband's death was legitimate. Under the Roman law the Decenviri established that a woman may bear a viable child at the tenth month of pregnancy. Paulus Zacchias, *[830] physician to Pope Innocent X., declared that birth may be retarded to the tenth month, and sometimes to a longer period. A case was decided in the Supreme Court of Friesland, a province in the northern part of the Netherlands, October, 1634, in which a child born three hundred and thirty-three days after the death of the husband was pronounced legitimate. The Parliament of Paris was gallant enough to come to the rescue of a widow and save her
of the legitimacy of an infant; the Scottish law, three hundred days; and the Prussian law, three hundred and one days.
There are numerous cases recorded by the older writers. Amman *[128] has one of twelve months' duration; Enguin, [2.97] one of twelve months';
Buchner, [2.98] a case of twelve months'; Benedictus, *[196] one of fourteen months'; de Blegny, [2.99] one of nineteen months'; Marteau, [2.100] Osiander, and others of forty-two and forty-four weeks'; and Stark's Archives, [2.101] one of forty-five
Thormeau writes from Tours, 1580, of a case of gestation prolonged to the twenty-third month, and Santorini, at Venice, in 1721, describes a similar case, the child reaching adult life. Elvert [2.104] records a case of late pregnancy, and Henschel *[495] one of forty-six weeks, but the fetus was dead. Schneider [2.105] cites an instance of three hundred and eight days' duration. Campbell says [2.106] that Simpson had cases of three hundred and nineteen, three hundred and thirty-two, and three hundred and thirty-six days'; Meigs had one of four hundred and twenty. James Reid, in a table of 500 mature births, gives 14 as being from three hundred and two to three hundred and fifteen days'.
Not so long ago a jury rendered a verdict of guilty of fornication and bastardy when it was alleged that the child was born three hundred and seventeen days after intercourse. Taylor relates a case of pregnancy in which the wife of a laborer went to America three hundred and twenty-two days before the birth. Jaffe [2.107] describes an instance of the prolongation of pregnancy for three hundred and sixty-five days, in which the developments and measurements corresponded to the length of protraction. Bryan [2.108] speaks of a woman of twenty-five who became pregnant on February 10, 1876, and on June 17th felt motion. On July 28th she was threatened with miscarriage, and by his advice the woman weaned the child at the breast. She expected to be confined the middle of November, 1876, but the expected event did not occur until April 26, 1877, nine months after the quickening and four hundred and forty days from the time of conception. The boy was active and weighed nine pounds. The author cites Meigs' case, and also one of Atlee's, at three hundred and fifty-six days.
Talcott, [2.109] Superintendent of the State Homeopathic Asylum for the Insane, explained the pregnancy of an inmate who had been confined for four years in this institution as one of protracted labor. He said that many such cases have been reported, and that something less than two years before he had charge of a case in which the child was born. He made the report to the New York Senate Commission on Asylums for the Insane as one of three years' protraction. Tidd [2.110] speaks of a woman who was delivered of a male child at term, and again in ten months delivered of a well-developed male child weighing 7 1/4 pounds; he relates the history of another case, in Clifton, W. Va., of a woman expecting confinement on June 1st going over
Two extraordinary cases are mentioned, [2.111] one in a woman of thirty-five, who expected to be confined April 24, 1883. In May she had a few labor-pains that passed away, and during the next six months she remained about as large as usual, and was several times thought to be in the early stages of labor. In September the os dilated until the first and second fingers could be passed directly to the head. This condition lasted about a month, but passed away. At times during the last nine months of pregnancy she was almost unable to endure the movements of the child. Finally, on the morning of November 6th, after a pregnancy of four hundred and seventy-six days, she was delivered of a male child weighing 13 pounds. Both the mother and child did well despite the use of chloroform and forceps. The other case was one lasting sixteen months and twenty days.
In a rather loose argument, Carey reckons a case of three hundred and fifty days. Menzie [2.112] gives an instance in a woman aged twenty-eight, the mother of one child, in whom a gestation was prolonged to the seventeenth month. The pregnancy was complicated by carcinoma of the uterus. Ballard [2.113] describes the case of a girl of sixteen years and six months, whose pregnancy, the result of a single intercourse, lasted three hundred and sixty days. Her labor was short and easy for a primipara, and the child was of the average size. Mackenzie [2.114] cites the instance of a woman aged thirty-two, a primipara, who had been married ten years and who always had been regular in menstruation. The menses ceased on April 28, 1888, and she felt the child for the first time in September. She had false pains in January, 1889, and labor did not begin until March 8th, lasting sixty-six hours. If all these statements are correct, the probable duration of this pregnancy was eleven months and ten days.
Lundie [2.115] relates an example of protracted gestation of eleven months, in which an anencephalous fetus was born; and Martin of Birmingham describes a similar case of ten and a half months' duration. Raux-Tripier [2.116] has seen protraction to the thirteenth month. Enguin [2.117] reports an observation of an accouchement of twins after a pregnancy that had been prolonged for eleven months. Resnikoff [2.118] mentions a pregnancy of eleven months' duration in an anemic secundipara. The case had been under his observation from the beginning of pregnancy; the patient would not submit to artificial termination at term, which he advised. After a painful labor of twenty-four hours a macerated and decomposed child was born, together with a closely-adherent placenta. Tarnier [2.119] reports an instance of partus serotinus in which the product of conception was carried in the uterus forty
Among others reporting instances of protracted pregnancy are Collins, [2.120] eleven months; Desbrest, [2.121] eighteen months; Henderson, [2.122] fifteen months; Jefferies, [2.123] three hundred and fifty-eight days, and De la Vergne [2.124] gives the history of a woman who carried an infant in her womb for twenty-nine months; this case may possibly belong under the head of fetus long retained in the uterus.
Unconscious Pregnancy.—There are numerous instances of women who have had experience in pregnancy unconsciously going almost to the moment of delivery, yet experiencing none of the usual accompanying symptoms of this condition. Crowell [2.125] speaks of a woman of good social position who had been married seven years, and who had made extensive preparations for a long journey, when she was seized with a "bilious colic,'' and, to her dismay and surprise, a child was born before the arrival of the doctor summoned on account of her sudden colic and her inability to retain her water. A peculiar feature of this case was the fact that mental disturbance set in immediately afterward, and the mother became morbid and had to be removed to an asylum, but recovered in a few months. Tanner [2.126] saw a woman of forty-two who had been suffering with abdominal pains. She had been married three years and had never been pregnant. Her catamenia were very scant, but this was attributed to her change of life. She had conceived, had gone to the full term of gestation, and was in labor ten hours without any suspicion of pregnancy. She was successfully delivered of a girl, which occasioned much rejoicing in the household.
Tasker of Kendall's Mills, Me., reports the case of a young married woman calling him for bilious colic. He found the stomach slightly distended and questioned her about the possibility of pregnancy. Both she and her husband informed him that such could not be the case, as her courses had been regular and her waist not enlarged, as she had worn a certain corset all the time. There were no signs of quickening, no change in the breasts, and,
Isham [2.128] speaks of a case of unconscious pregnancy in which extremely small twins were delivered at the eighth month. Fox [2.129] cites an instance of a woman who had borne eight children, and yet unconscious of pregnancy. Merriman [2.130] speaks of a woman forty years of age who had not borne a child for nine years, but who suddenly gave birth to a stout, healthy boy without being cognizant of pregnancy. Dayral [2.131] tells of a woman who carried a child all through pregnancy, unconscious of her condition, and who was greatly surprised at its birth. Among the French observers speaking of pregnancy remaining unrecognized by the mother until the period of accouchement, Lozes and Rhades [2.132] record peculiar cases; and Mouronval [2.133] relates an instance in which a woman who had borne three children completely ignored the presence of pregnancy until the pains of labor were felt. Fleishman [2.134] and Munzenthaler also record examples of unconscious pregnancy.
Pseudocyesis.—On the other hand, instances of pregnancy with imaginary symptoms and preparations for birth are sometimes noticed, and many cases are on record. In fact, nearly every text-book on obstetrics gives some space to the subject of pseudocyesis. Suppression of the menses, enlargement of the abdomen, engorgement of the breasts, together with the symptoms produced by the imagination, such as nausea, spasmodic contraction of the abdomen, etc., are for the most part the origin of the cases of pseudocyesis. Of course, many of the cases are not examples of true pseudocyesis, with its interesting phenomena, but instances of malingering for mercenary or other purposes, and some are calculated to deceive the most expert obstetricians by their tricks. Weir Mitchell [2.135] delineates an interesting case of pseudocyesis as follows: "A woman, young, or else, it may be, at or past the climacteric, eagerly desires a child or is horribly afraid of becoming pregnant. The menses become slight in amount, irregular, and at last cease or not. Meanwhile the abdomen and breasts enlarge, owing to a rapid taking on of fat, and this is far less visible elsewhere. There comes with this excess of fat the most profound conviction of the fact of pregnancy. By
"Another instance I saw when in general practice. A lady who had several children and suffered much in her pregnancies passed five years without becoming impregnated. Then she missed a period, and had, as usual, vomiting. She made some wild efforts to end her supposed pregnancy, and failing, acquiesced in her fate. The menses returned at the ninth month and were presumed to mean labor. Meanwhile she vomited, up to the eighth month, and ate little. Nevertheless, she took on fat so as to make the abdomen and breasts immense and to excite unusual attention. No physician examined her until the supposed labor began, when, of course, the truth came out. She was pleased not to have another child, and in her case, as in all the others known to me, the fat lessened as soon as the mind was satisfied as to the non-existence of pregnancy. As I now recall the facts, this woman was not more than two months in getting rid of the excess of adipose tissue. Dr. Hirst tells me he has met with cases of women taking on fat with cessation of the menses, and in which there was also a steady belief in the existence of pregnancy. He has not so followed up these cases as to know if in them the fat fell away with speed when once the patient was assured that no child existed within her.''
Hirst, [2.136] in an article on the difficulties in the diagnosis of pregnancy, gives several excellent photographs showing the close resemblance between several pathologic conditions and the normal distention of the abdomen in pregnancy (Plate 2). A woman [2.137] who had several children fell sick with a chest-affection, followed by an edema. For fifteen months she was confined to her bed, and had never had connection with her husband during that time. Her menses ceased; her mammæ became engorged and discharged a serous lactescent fluid; her belly enlarged, and both she and her physician felt fetal movements in her abdomen. As in her previous pregnancies, she suffered nausea. Naturally, a suspicion as to her virtue came into her husband's mind, but when he considered that she had never left her bed for fifteen months he thought the pregnancy impossible. Still the wife insisted that she was pregnant and was confirmed in the belief by a midwife. The belly continued to increase, and about eleven months after the cessation of the menses she had the pains of labor. Three doctors and an accoucheur were present, and when they claimed that the fetal head presented the husband gave up in despair; but the supposed fetus was born shortly after, and proved to be only a mass of hydatids, with not the sign of a true pregnancy. Girard of Lyons [2.138] speaks of a female who had been pregnant several times, but again experienced the signs of pregnancy. Her mammæ were engorged with a lactescent fluid, and she felt belly-movements like those of a child; but during all this time she had regular menstruation. Her abdomen progressively increased in size, and between the tenth and eleventh months she suffered what she thought to be labor-pains. These false pains ceased upon taking a bath, and with the disappearance of the other signs was dissipated the fallacious idea of pregnancy.
There is mentioned [2.139] an instance of medicolegal interest of a young girl who showed all the signs of pregnancy and confessed to her parents that she had had commerce with a man. The parents immediately prosecuted the seducer by strenuous legal methods, but when her ninth month came, and after the use of six baths, all the signs of pregnancy vanished. Harvey cites several instances of pseudocyesis, and says we must not rashly determine of the the inordinate birth before the seventh or after the eleventh month. In 1646 a woman, after having laughed heartily at the jests of an ill-bred, covetous clown, was seized with various movements and motions in her belly like those of a child, and these continued for over a month, when the courses appeared again and the movements ceased. The woman was certain that she was pregnant.
The most noteworthy historic case of pseudocyesis is that of Queen Mary of England, or "Bloody Mary,'' as she was called. To insure the succession of a Catholic heir, she was most desirous of having a son by her consort,
Philip, and she constantly prayed and wished for pregnancy. Finally her
Putnam [2.140] cites the case of a healthy brunet, aged forty, the mother of three children. She had abrupt vertical abdominal movements, so strong as to cause her to plunge and sway from side to side. Her breasts were enlarged, the areolæ dark, and the uterus contained an elastic tumor, heavy and rolling under the hand. Her abdomen progressively enlarged to the regular size of matured gestation; but the extrauterine pregnancy, which was supposed to have existed, was not seen at the autopsy, nothing more than an enlarged liver being found. The movement was due to spasmodic movements of the abdominal muscles, the causes being unknown. Madden [2.141] gives the history of a primipara of twenty-eight, married one year, to whom he was called. On entering the room he was greeted by the midwife, who said she expected the child about 8 P. M. The woman was lying in the usual obstetric position, on the left side, groaning, crying loudly, and pulling hard at a strap fastened to the bed-post. She had a partial cessation of menses, and had complained of tumultuous movements of the child and overflow of milk from the breasts. Examination showed the cervix low down, the os small and circular, and no signs of pregnancy in the uterus. The abdomen was distended with tympanites and the rectum much dilated with accumulated feces. Dr. Madden left her, telling her that she was not pregnant, and when she reappeared at his office in a few days, he reassured her of the nonexistence of pregnancy; she became very indignant, triumphantly squeezed lactescent fluid from her breasts, and, insisting that she could feel fetal movements, left to seek a more sympathetic accoucheur. Underhill, [2.142] in the words of Hamilton, describes a woman as "having acquired the most accurate description of the breeding symptoms, and with wonderful facility imagined that she had felt every one of them.'' He found the woman on a bed complaining of great labor-pains, biting a handkerchief, and pulling on a cloth
Haultain [2.143] gives three examples of pseudocyesis, the first with no apparent cause, the second due to carcinoma of the uterus, while in the third there was a small fibroid in the anterior wall of the uterus. Some cases are of purely nervous origin, associated with a purely muscular distention of the abdomen. Clay reported a case due to ascites. Cases of pseudocyesis in women convicted of murder are not uncommon, though most of them are imposters hoping for an extra lease of life.
Croon [2.144] speaks of a child seven years old on whom he performed ovariotomy for a round-celled sarcoma. She had been well up to May, but since then she had several times been raped by a boy, in consequence of which she had constant uterine hemorrhage. Shortly after the first coitus her abdomen began to enlarge, the breasts to develop, and the areolæ to darken. In seven months the abdomen presented the signs of pregnancy, but the cervix was soft and patulous; the sound entered three inches and was followed by some hemorrhage. The child was well developed, the mons was covered with hair, and all the associate symptoms tended to increase the deception.
Sympathetic Male Nausea of Pregnancy.—Associated with pregnancy there are often present morning-nausea and vomiting as prominent and reliable symptoms. Vomiting is often so excessive as to be provocative of most serious issue and even warranting the induction of abortion. This fact is well known and has been thoroughly discussed, but with it is associated an interesting point, the occasional association of the same symptoms sympathetically in the husband. The belief has long been a superstition in parts of Great Britain, descending to America, and even exists at the present day. Sir Francis Bacon has written on this subject, the substance of his argument being that certain loving husbands so sympathize with their pregnant wives that they suffer morning-sickness in their own person. No less an authority than S. Weir Mitchell called attention to the interesting subject of sympathetic vomiting in the husband in his lectures on nervous maladies some years ago. He also quotes the following case associated with pseudocyesis:—
"A woman had given birth to two female children. Some years passed and her desire for a boy was ungratified. Then she missed her flow once, and had thrice after this, as always took place with her when pregnant, a very small but regular loss. At the second month morning-vomiting came on as usual with her. Meanwhile she became very fat, and as the growth was largely, in fact excessively, abdominal, she became easily sure of her condition. She was not my patient, but her husband consulted me as to his own
Hamill [2.145] reports an instance of morning-sickness in a husband two weeks after the appearance of menstruation in the wife for the last time. He had daily attacks, and it was not until the failure of the next menses that the woman had any other sign of pregnancy than her husband's nausea. His nausea continued for two months, and was the same as that which he had suffered during his wife's former pregnancies, although not until both he and his wife became aware of the existence of pregnancy. The Lancet [2.146] describes a case in which the husband's nausea and vomiting, as well as that of the wife, began and ended simultaneously. Judkins [2.147] cites an instance of a man who was sick in the morning while his wife was carrying a child. This occurred during every pregnancy, and the man related that his own father was similarly affected while his mother was in the early months of pregnancy with him, showing an hereditary predisposition.
The perverted appetites and peculiar longings of pregnant women furnish curious matter for discussion. From the earliest times there are many such records. Borellus cites an instance, and there are many others, of pregnant women eating excrement with apparent relish. Tulpius, Sennert, Langius, van Swieten, à Castro, and several others report depraved appetites. Several writers have seen avidity for human flesh in such females. Fournier [2.148] knew a woman with an appetite for the blood of her husband. She gently cut him while he lay asleep by her side and sucked blood from the wounds—a modern "Succubus.'' Paré [2.149] mentions the perverted appetites of pregnant women, and says that they have been known to eat plaster, ashes, dirt, charcoal, flour, salt, spices, to drink pure vinegar, and to indulge in all forms of debauchery. Plot *[637] gives the case of a woman who would gnaw and eat all the linen off her bed. Hufeland's Journal *[452] records the history of a case of a woman of thirty-two, who had been married ten years, who acquired a strong taste for charcoal, and was ravenous for it. It seemed to cheer her and to cure a supposed dyspepsia. She devoured enormous quantities, preferring hard-wood charcoal. Bruyesinus *[228] speaks of a woman who had a most perverted appetite for her own milk, and constantly drained her breasts; Krafft-Ebing cites a similar case. Another case *[280] is that of a pregnant woman who had a desire for hot and pungent articles of food, and who in a short time devoured a pound of pepper. Scheidemantel cites a
Many instances could be quoted, some in which extreme cases of polydipsia and bulimia developed; these can be readily attributed to the increased call for liquids and food. Other cases of diverse new emotions can be recalled, such as lasciviousness, dirty habits, perverted thoughts, and, on the other hand, extreme piety, chastity, and purity of the mind. Some of the best-natured women are when pregnant extremely cross and irritable and many perversions of disposition are commonly noticed in pregnancy. There is often a longing for a particular kind of food or dish for which no noticeable desire had been displayed before.
Maternal Impressions.—Another curious fact associated with pregnancy is the apparent influence of the emotions of the mother on the child in utero. Every one knows of the popular explanation of many birth-marks, their supposed resemblance to some animal or object seen by the mother during pregnancy, etc. The truth of maternal impressions, however, seems to be more firmly established by facts of a substantial nature. There is a natural desire to explain any abnormality or anomaly of the child as due to some incident during the period of the mother's pregnancy, and the truth is often distorted and the imagination heavily drawn upon to furnish the satisfactory explanation. It is the customary speech of the dime-museum lecturer to attribute the existence of some "freak'' to an episode in the mother's pregnancy. The poor "Elephant-man'' firmly believed his peculiarity was due to the fact that his mother while carrying him in utero was knocked down at the circus by an elephant. In some countries the exhibition of monstrosities is forbidden because of the supposed danger of maternal impression. The celebrated "Siamese Twins'' for this reason were forbidden to exhibit themselves for quite a period in France.
We shall cite only a few of the most interesting cases from medical literature. Hippocrates saved the honor of a princess, accused of adultery with a negro because she bore a black child, by citing it as a case of maternal impression, the husband of the princess having placed in her room a painting of a negro, to the view of which she was subjected during the whole of her pregnancy. Then, again, in the treatise "De Superfœtatione'' there occurs the following distinct statement: "If a pregnant woman has a longing to eat earth or coals, and eats of them, the infant which is born carries on its head the mark of these things.'' This statement, however, occurs in a work which is not mentioned by any of the ancient authorities, and is rejected by practically all the modern ones; according to Ballantyne, there is, therefore, no absolute proof that Hippocrates was a believer in one of the most popular and long-persisting beliefs concerning fetal deformities.
In the explanation of heredity, Hippocrates [2.151] states "that the body of the male as well as that of the female furnishes the semen. That which is weak (unhealthy) is derived from weak (unhealthy) parts, that which is strong (healthy) from strong (healthy) parts, and the fetus will correspond to the quality of the semen. If the semen of one part come in greater quantity from the male than from the female, this part will resemble more closely the father; if, however, it comes more from the female, the part will rather resemble the mother. If it be true that the semen comes from both parents, then it is impossible for the whole body to resemble either the mother or the father, or neither the one nor the other in anything, but necessarily the child will resemble both the one and the other in something. The child will most resemble the one who contributes most to the formation of the parts.'' Such was the Hippocratic theory of generation and heredity, and it was ingeniously used to explain the hereditary nature of certain diseases and malformations. For instance, in speaking of the sacred disease (epilepsy), Hippocrates says: "Its origin is hereditary, like that of other diseases; for if a phlegmatic person be born of a phlegmatic, and a bilious of a bilious, and a phthisical of a phthisical, and one having spleen disease of another having disease of the spleen, what is to hinder it from happening that where the father and mother were subject to this disease certain of their offspring should be so affected also? As the semen comes from all parts of the body, healthy particles will come from healthy parts, and unhealthy from unhealthy parts.''
According to Paré, *[618] Damascene saw a girl with long hair like a bear, whose mother had constantly before her a picture of the hairy St. John. Paré also appends an illustration showing the supposed resemblance to a bear. Jonston *[447] quotes a case of Heliodorus; it was an Ethiopian, who by the effect of the imagination produced a white child. Paré *[618] describes this case more fully: "Heliodorus says that Persina, Queen of Ethiopia, being impregnated by Hydustes, also an Ethiopian, bore a daughter with a white skin, and the anomaly was ascribed to the admiration that a picture of Andromeda excited in Persina throughout the whole of the pregnancy.'' Van Helmont *[413] cites the case of a tailor's wife at Mechlin, who during a conflict outside her house, on seeing a soldier lose his hand at her door, gave birth to a daughter with one hand, the other hand being a bleeding stump; he also speaks of the case of the wife of a merchant at Antwerp, who after seeing a soldier's arm shot off at the siege of Ostend gave birth to a daughter with one arm. Plot *[637] speaks of a child bearing the figure of a mouse; when pregnant, the mother had been much frightened by one of these animals. Gassendus *[356] describes a fetus with the traces of a wound in the same location as one received by the mother. The Lancet [2.152] speaks of several cases— one of a child with a face resembling a dog whose mother had been bitten; one
Hunt [2.155] describes a case which has since become almost classic of a woman fatally burned, when pregnant eight months, by her clothes catching fire at the kitchen grate. The day after the burns labor began and was terminated by the birth of a well-formed dead female child, apparently blistered and burned in extent and in places corresponding almost exactly to the locations of the mother's injuries. The mother died on the fourth day.
Webb [2.156] reports the history of a negress who during a convulsion while pregnant fell into a fire, burning the whole front of the abdomen, the front and inside of the thighs to the knees, the external genitals, and the left arm. Artificial delivery was deemed necessary, and a dead child, seemingly burned much like its mother, except less intensely, was delivered. There was also one large blister near the inner canthus of the eye and some large blisters about the neck and throat which the mother did not show. There was no history of syphilis nor of any eruptive fever in the mother, who died on the tenth day with tetanus.
Graham [2.157] describes a woman of thirty-five, the mother of seven children, who while pregnant was feeding some rabbits, when one of the animals jumped at her with its eyes "glaring'' upon her, causing a sudden fright. Her child was born hydrocephalic. Its mouth and face were small and rabbit-shaped. Instead of a nose, it had a fleshy growth 3/4 inch long by 1/4 inch broad, directed upward at an angle of 45°. The space between this and the mouth was occupied by a body resembling an adult eye. Within this were two small, imperfect eyes which moved freely while life lasted (ten minutes). The child's integument was covered with dark, downy, short hair. The woman recovered and afterward bore two normal children.
Parvin mentions an instance of the influence of maternal impression in the causation of a large, vivid, red mark or splotch on the face: "When the mother was in Ireland she was badly frightened by a fire in which some cattle were burned. Again, during the early months of her pregnancy she was frightened by seeing another woman suddenly light the fire with kerosene, and at that time became firmly impressed with the idea that her child would be marked.'' Parvin [2.158] also pictures the "turtle-man,'' an individual with deformed extremities, who might be classed as an ectromelus, perhaps as a phocomelus, or seal-like monster. According to the story, when the mother was a few weeks pregnant her husband, a coarse, rough fisherman, fond of rude jokes, put a large live turtle in the cupboard. In the twilight the wife went to the cupboard and the huge turtle fell out, greatly startling her by its hideous appearance as it fell suddenly to the floor and began to move vigorously.
Fig. 8.—The "turtle-man."
[Description: Illustration of the "turtle-man"]
Copeland [2.159] mentions a curious case in which a woman was attacked by a rattlesnake when in her sixth month of pregnancy, and gave birth to a child whose arm exhibited the shape and action of a snake, and involuntarily went through snake-like movements. The face and mouth also markedly resembled the head of a snake. The teeth were situated like a serpent's fangs. The mere mention of a snake filled the child (a man of twenty-nine) with great horror and rage, "particularly in the snake season.'' Beale [2.160] gives the history of a case of a child born with its left eye blackened as by a blow, whose mother was struck in a corresponding portion of the face eight hours before confinement. There is on record [2.161] an account of a young man of twenty-one suffering from congenital deformities attributed to the fact that his mother was frightened by a guinea-pig having been thrust into her face during pregnancy. He also had congenital deformity of the right auricle. At the autopsy, all the skin, tissues, muscles, and bones were found involved. Owen [2.162] speaks of a woman who was greatly excited ten months previously by a prurient curiosity to see what appearance the genitals of her brother presented after he had submitted to amputation of the penis on account of carcinoma. The whole penis had been removed. The woman stated that from the time she had thus satisfied herself, her mind was unceasingly engaged in reflecting and sympathizing on the forlorn condition of her brother. While in this mental state she gave birth to a son whose penis was entirely absent, but who was otherwise well and likely to live. The other portions of the genitals were perfect and well developed. The appearance of
Mackay [2.165] describes five cases in which fright produced distinct marks on the fetus. There is a case mentioned [2.166] in which a pregnant woman was informed that an intimate friend had been thrown from his horse; the immediate cause of death was fracture of the skull, produced by the corner of a dray against which the rider was thrown. The mother was profoundly impressed by the circumstance, which was minutely described to her by an eye-witness. Her child at birth presented a red and sensitive area upon the scalp corresponding in location with the fatal injury in the rider. The child is now an adult woman, and this area upon the scalp remains red and sensitive to pressure, and is almost devoid of hair. Mastin of Mobile, Alabama, reports a curious instance of maternal impression. During the sixth month of the pregnancy of the mother her husband was shot, the ball passing out through the left breast. The woman was naturally much shocked, and remarked to Dr. Mastin: "Doctor, my baby will be ruined, for when I saw the wound I put my hands over my face, and got it covered with blood, and I know my baby will have a bloody face.'' The child came to term without a bloody face. It had, however, a well-defined spot on the left breast just below the site of exit of the ball from its father's chest. The spot was about the size of a silver half-dollar, and had elevated edges of a bright red color, and was quite visible at the distance of one hundred feet. The authors have had personal communication with Dr. Mastin in regard to this case, which he considers the most positive evidence of a case of maternal impression that he has ever met.
Paternal Impressions.—Strange as are the foregoing cases, those of paternal impression eclipse them. Several are on record, but none are of sufficient authenticity to warrant much discussion on the subject. Those below are given to illustrate the method of report. Stahl, quoted by Steinan, 1843, speaks of the case of a child, the father being a soldier who lost an eye in the war. The child was born with one of its eyes dried up in the orbit, in this respect presenting an appearance like that of the father. Schneider [2.167]
Telegony.—The influence of the paternal seed on the physical and mental constitution of the child is well known. To designate this condition, Telegony is the word that was coined by Weismann in his "Das Keimplasma,'' and he defines it as "Infection of the Germ,'' and, at another time, as "Those doubtful instances in which the offspring is said to resemble, not the father, but an early mate of the mother,''—or, in other words, the alleged influence of a previous sire on the progeny produced by a subsequent one from the same mother. In a systematic discussion of telegony before the Royal Medical Society, Edinburgh, on March 1, 1895, [2.170] Brunton Blaikie, as a means of making the definition of telegony plainer by practical example, prefaced his remarks by citing the classic example which first drew the attention of the modern scientific world to this phenomenon. The facts of this case were communicated in a letter from the Earl of Morton to the President of the Royal Society in 1821, and were as follows: In the year 1816 Lord Morton put a male quagga to a young chestnut mare of 7/8 Arabian blood, which had never before been bred from. The result was a female hybrid which resembled both parents. He now sold the mare to Sir Gore Ousley, who two years after she bore the hybrid put her to a black Arabian horse. During the two following years she had two foals which Lord Morton thus describes: "They have the character of the Arabian breed as decidedly as can be expected when 15/16 of the blood are Arabian, and they are fine specimens of the breed; but both in their color and in the hair of their manes they have a striking resemblance to the quagga. Their color is bay, marked more or less like the quagga in a darker tint. Both are distinguished by the dark line along the ridge of the back, the dark stripes across the forehand, and the dark bars across the back part of the legs.'' The President of the Royal Society saw the foals and verified Lord Morton's statement.
"Herbert Spencer, in the Contemporary Review for May, 1893, gives several cases communicated to him by his friend Mr. Fookes, whom Spencer says is often appointed judge of animals at agricultural shows. After giving
"Lord Polwarth, whose very fine breed of Border Leicesters is famed throughout Britain, and whose knowledge on the subject of breeding is great, says that `In sheep we always consider that if a ewe breeds to a Shrop ram, she is never safe to breed pure Leicesters from, as dun or colored legs are apt to come even when the sire is a pure Leicester. This has been proved in various instances, but is not invariable.' ''
Hon. Henry Scott says: "Dog-breeders know this theory well; and if a pure-bred bitch happens to breed to a dog of another breed, she is of little use for breeding pure-bred puppies afterward. Animals which produce large litters and go a short time pregnant show this throwing back to previous sires far more distinctly than others—I fancy dogs and pigs most of all, and probably horses least. The influence of previous sires may be carried into the second generation or further, as I have a cat now which appears to be half Persian (long hair). His dam has very long hair and every appearance of being a half Persian, whereas neither have really any Persian blood, as far as I know, but the grand-dam (a very smooth-haired cat) had several litters by a half-Persian tom-cat, and all her produce since have showed the influence retained. The Persian tom-cat died many years ago, and was the only one in the district, so, although I cannot be absolutely positive, still I think this case is really as stated.''
Breeders of Bedlington terriers wish to breed dogs with as powerful jaws as possible. In order to accomplish this they put the Bedlington terrier bitch first to a bull-terrier dog, and get a mongrel litter which they destroy. They now put the bitch to a Bedlington terrier dog and get a litter of puppies which are practically pure, but have much stronger jaws than they would otherwise have had, and also show much of the gameness of the bull-terrier, thus proving that physiologic as well as anatomic characters may be transmitted in this way.
After citing the foregoing examples, Blaikie directs his attention to man, and makes the following interesting remarks:—
"We might expect from the foregoing account of telegony amongst animals that whenever a black woman had a child to a white man, and then married a black man, her subsequent children would not be entirely black. Dr. Robert Balfour of Surinam in 1851 wrote to Harvey that he was continually noticing amongst the colored population of Surinam `that if a negress
"Dr. Harvey mentions a case in which `a young woman, residing in Edinburgh, and born of white (Scottish) parents, but whose mother, some time previous to her marriage, had a natural (mulatto) child by a negro man-servant in Edinburgh, exhibits distinct traces of the negro. Dr. Simpson —afterward Sir James Simpson—whose patient the young woman at one time was, has had no recent opportunities of satisfying himself as to the precise extent to which the negro character prevails in her features; but he recollects being struck with the resemblance, and noticed particularly that the hair had the qualities characteristic of the negro.' Herbert Spencer got a letter from a `distinguished correspondent' in the United States, who said that children by white parents had been `repeatedly' observed to show traces of black blood when the women had had previous connection with (i. e., a child by) a negro. Dr. Youmans of New York interviewed several medical professors, who said the above was `generally accepted as a fact.' Prof. Austin Flint, in `A Text-book of Human Physiology,' mentioned this fact, and when asked about it said: `He had never heard the statement questioned.'
"But it is not only in relation to color that we find telegony to have been noticed in the human subject. Dr. Middleton Michel gives a most interesting case in the American Journal of the Medical Sciences for 1868: `A black woman, mother of several negro children, none of whom were deformed in any particular, had illicit intercourse with a white man, by whom she became pregnant. During gestation she manifested great uneasiness of mind, lest the birth of a mulatto offspring should disclose her conduct. . . . It so happened that her negro husband possessed a sixth digit on each hand, but there was no peculiarity of any kind in the white man, yet when the mulatto child was born it actually presented the deformity of a supernumerary finger.' Taruffi, the celebrated Italian teratologist, in speaking of the
"An observation probably having some bearing on this subject was made by Count de Stuzeleci (Harvey, loc. cit.). He noticed that when an aboriginal female had had a child by a European, she lost the power of conception by a male of her own race, but could produce children by a white man. He believed this to be the case with many aboriginal races; but it has been disproved, or at all events proved to be by no means a universal law, in every case except that of the aborigines of Australia and New Zealand. Dr. William Sedgwick thought it probable that the unfruitfulness of prostitutes might in some degree be due to the same cause as that of the Australian aborigines who have had children by white men.
"It would seem as though the Israelites had had some knowledge of telegony, for in Deuteronomy we find that when a man died leaving no issue, his wife was commanded to marry her husband's brother, in order that he might `raise up seed to his brother.' ''
We must omit the thorough inquiry into this subject that is offered by Mr. Blaikie. The explanations put forward have always been on one of three main lines:—
(1) The imagination-theory, or, to quote Harvey: "Due to mental causes so operating either on the mind of the female and so acting on her reproductive powers, or on the mind of the male parent, and so influencing the qualities of his semen, as to modify the nutrition and development of the offspring.''
(2) Due to a local influence on the reproductive organs of the mother.
(3) Due to a general influence through the fetus on the mother
Antenatal Pathology.—We have next to deal with the diseases, accidents, and operations that affect the pregnant uterus and its contents; these are rich in anomalies and facts of curious interest, and have been recognized from the earliest times. In the various works usually grouped together under the general designation of "Hippocratic'' are to be found
The first to be considered is the transmission of contagious disease to the fetus in utero. The first disease to attract attention was small-pox. Devilliers, Blot, and Depaul all speak of congenital small-pox, the child born dead and showing evidences of the typical small-pox pustulation, with a history of the mother having been infected during pregnancy. Watson [2.171] reports two cases in which a child in utero had small-pox. In the first case the mother was infected in pregnancy; the other was nursing a patient when seven months pregnant; she did not take the disease, although she had been infected many months before. Mauriceau *[513] delivered a woman of a healthy child at full term after she had recovered from a severe attack of this disease during the fifth month of gestation. Mauriceau supposed the child to be immune after the delivery. Vidal reported to the French Academy of Medicine, May, 1871, the case of a woman who gave birth to a living child of about six and one-half months' maturation, which died some hours after birth covered with the pustules of seven or eight days' eruption. The pustules on the fetus were well umbilicated and typical, and could have been nothing but those of small-pox; besides, this disease was raging in the neighborhood at the time. The mother had never been infected before, and never was subsequently. Both parents were robust and neither of them had ever had syphilis. About the time of conception, the early part of December, 1870, the father had suffered from the semiconfluent type, but the mother, who had been vaccinated when a girl, had never been stricken either during or after her husband's sickness. Quirke [2.172] relates a peculiar instance of a child born at midnight, whose mother was covered with the eruption eight hours after delivery. The child was healthy and showed no signs of the contagion, and was vaccinated at once. Although it remained with its mother all through the sickness, it continued well, with the exception of the ninth day, when a slight fever due to its vaccination appeared. The mother made a good recovery, and the author remarks that had the child been born a short time later, it would most likely have been infected.
Ayer [2.173] reports an instance of congenital variola in twins. Chantreuil [2.174]
Varicella, Measles, Pneumonia, and even Malaria are reported as having been transmitted to the child in utero. Hubbard [2.177] attended a woman on March 17, 1878, in her seventh accouchement. The child showed the rash of varicella twenty-four hours after birth, and passed through the regular coarse of chicken-pox of ten days' duration. The mother had no signs of the disease, but the children all about her were infected. Ordinarily the period of incubation is from three to four days, with a premonitory fever of from twenty-four to seventy-two hours' duration, when the rash appears; this case must therefore have been infected in utero. Lomer [2.178] of Hamburg tells of the case of a woman, twenty-two years, unmarried, pregnant, who had measles in the eighth month, and who gave birth to an infant with measles. The mother was attacked with pneumonia on the fifth day of her puerperium, but recovered; the child died in four weeks of intestinal catarrh. Gautier [2.179] found measles transmitted from the mother to the fetus in 6 out of 11 cases, there being 2 maternal deaths in the 11 cases.
Netter [2.180] has observed the case of transmission of pneumonia from a mother to a fetus, and has seen two cases in which the blood from the uterine vessels of patients with pneumonia contained the pneumococcus. Wallick [2.181] collected a number of cases of pneumonia occurring during pregnancy, showing a fetal mortality of 80 per cent.
Felkin [2.182] relates two instances of fetal malaria in which the infection was probably transmitted by the male parent. In one case the father near term suffered severely from malaria; the mother had never had a chill. The violent fetal movements induced labor, and the spleen was so large as to retard it. After birth the child had seven malarial paroxysms but recovered, the splenic tumor disappearing.
The modes of infection of the fetus by syphilis, and the infection of the mother, have been well discussed, and need no mention here.
There has been much discussion on the effects on the fetus in utero of medicine administered to the pregnant mother, and the opinions as to the reliability of this medication are so varied that we are in doubt as to a satisfactory conclusion. The effects of drugs administered and eliminated by the mammary glands and transmitted to the child at the breast are well known, and have been witnessed by nearly every physician, and, as in cases of strong metallic purges, etc., need no other than the actual test. However, scientific experiments as to the efficacy of fetal therapeutics have been made from time to time with varying results.
Gusserow of Strasbourg tested for iodin, chloroform, and salicylic acid in the blood and secretions of the fetus after maternal administration just before death. In 14 cases in which iodin had been administered, he examined the fetal urine of 11 cases; in 5, iodin was present, and in the others, absent. He made some similar experiments on the lower animals. Benicke reports having given salicylic acid just before birth in 25 cases, and in each case finding it in the urine of the child shortly after birth.
At a discussion held in New York some years ago as to the real effect on the fetus of giving narcotics to the mother, Dr. Gaillard Thomas was almost alone in advocating that the effect was quite visible. Fordyce Barker was strongly on the negative side. Henning and Ahlfeld, two German observers, vouch for the opinion of Thomas, and Thornburn states that he has witnessed the effect of nux vomica and strychnin on the fetus shortly after birth. Over fifty years ago, in a memoir on "Placental Phthisis,'' Sir James Y. Simpson advanced a new idea in the recommendation of potassium chlorate during the latter stages of pregnancy. The efficacy of this suggestion is known, and whether, as Simpson said, it acts by supplying extra oxygen to the blood, or whether the salt itself is conveyed to the fetus, has never been definitely settled.
McClintock, [2.183] who has been a close observer on this subject, reports some interesting cases. In his first case he tried a mixture of iron perchlorid and potassium chlorate three times a day on a woman who had borne three dead children, with a most successful result. His second case failed, but in a third he was successful by the same medication with a woman who had before borne a dead child. In a fourth case of unsuccessful pregnancy for three consecutive births he was successful. His fifth case was extraordinary: It was that of a woman in her tenth pregnancy, who, with one exception, had always borne a dead child at the seventh or eighth month. The one exception lived a few hours only. Under this treatment he was successful in carrying the woman safely past her time for miscarriage, and had every indication for a normal birth at the time of report. Thornburn believes that the administration of a tonic like strychnin is of benefit to a fetus which, by its feeble heart-beats and movements, is thought to be unhealthy.
In this important paper, Porak, after giving some historical notes, describes a long series of experiments performed on the guinea-pig in order to investigate the passage of arsenic, copper, lead, mercury, phosphorus, alizarin, atropin, and eserin through the placenta. The placenta shows a real affinity for some toxic substances; in it accumulate copper and mercury, but not lead, and it is therefore through it that the poison reaches the fetus; in addition to its pulmonary, intestinal, and renal functions, it fixes glycogen and acts as an accumulator of poisons, and so resembles in its action the liver; therefore the organs of the fetus possess only a potential activity. The storing up of poisons in the placenta is not so general as the accumulation of them in the liver of the mother. It may be asked if the placenta does not form a barrier to the passage of poisons into the circulation of the fetus; this would seem to be demonstrated by mercury, which was always found in the placenta and never in the fetal organs. In poisoning by lead and copper the accumulation of the poison in the fetal tissues is greater than in the maternal, perhaps from differences in assimilation and disassimilation or from greater diffusion. Whilst it is not an impermeable barrier to the passage of poisons, the placenta offers a varying degree of obstruction: it allows copper and lead to pass easily, arsenic with greater difficulty. The accumulation of toxic substances in the fetus does not follow the same law as in the adult. They diffuse more widely in the fetus. In the adult the liver is the chief accumulatory organ. Arsenic, which in the mother elects to accumulate in the liver, is in the fetus stored up in the skin; copper accumulates in the fetal liver, central nervous system, and sometimes in the skin; lead which is found specially in the maternal liver, but also in the skin, has been observed in the skin, liver, nervous centers, and elsewhere in the fetus. The frequent presence of poisons in the fetal skin demonstrates its physiologic importance. It has probably not a very marked influence on its health. On the contrary, accumulation in the placenta and nerve centers explains the pathogenesis of abortion and the birth of dead fetuses ("mortinatatité'') Copper and lead did not cause abortion, but mercury did so in two out of six cases. Arsenic is a powerful abortive agent in the guinea-pig, probably on account of placental hemorrhages. An important deduction is that whilst the placenta is frequently and seriously affected in syphilis, it is also the special seat for the accumulation of mercury. May this not explain its therapeutic action in this disease? The marked accumulation of lead in the central nervous system of the fetus explains the frequency and serious character of saturnine encephalopathic lesions. The presence of arsenic in the
Intrauterine amputations are of interest to the medical man, particularly those cases in which the accident has happened in early pregnancy and the child is born with a very satisfactory and clean stump. Montgomery, [2.185] in an excellent paper, advances the theory, which is very plausible, that intrauterine amputations are caused by contraction of bands or membranes of organized lymph encircling the limb and producing amputation by the same process of disjunctive atrophy that the surgeons induce by ligature. Weinlechner [2.186] speaks of a case in which a man devoid of all four extremities was exhibited before the Vienna Medical Society. The amputations were congenital, and on the right side there was a very small stump of the upper arm remaining, admitting the attachment of an artificial apparatus. He was twenty-seven years old, and able to write, to thread a needle, pour water out of a bottle, etc. Cook [2.187] speaks of a female child born of Indian parents, the fourth birth of a mother twenty-six years old. The child weighed 5 1/2 pounds; the circumference of the head was 14 inches and that of the trunk 13 inches. The upper extremities consisted of perfect shoulder joints, but only 1/4 of each humerus was present. Both sides showed evidences of amputation, the cicatrix on the right side being 1 inch long and on the left 1/4 inch long. The right lower limb was merely a fleshy corpuscle 3/4 inch wide and 1/4 inch long; to the posterior edge was attached a body resembling the little toe of a newly-born infant. On the left side the limb was represented by a fleshy corpuscle 1 inch long and 1/4 inch in circumference, resembling the great toe of an infant.
Fig. 9—Intrauterine amputatation(Cook).
[Description: Drawing of infant born without limbs]
There was no history of shock or injury to the mother. The child presented by the breech, and by the absence of limbs caused much difficulty in diagnosis. The three stages of labor were one and one-half hours, forty-five minutes, and five minutes, respectively. The accompanying illustration (Fig. 9) shows the appearance of the limbs at the time of report.
Figure 10 represents a negro boy, the victim of intrauterine amputation, who learned to utilize his toes for many purposes. The illustration shows his mode of holding his pen.
There is an instance reported [2.188] in which a child at full term was born with an amputated arm, and at the age of seventeen the stump was scarcely if at all smaller than the other. Blake [2.189] speaks of a case of congenital
The coilings of the cord are not limited to compression about the extremities alone, but may even decapitate the head by being firmly wrapped several times about the neck. According to Ballantyne, *[759] there is in the treatise De Octimestri Partu, by Hippocrates, a reference to coiling of the umbilical cord round the neck of the fetus. This coiling was, indeed, regarded as one of the dangers of the eighth month, and even the mode of its production is described. It is said that if the cord he extended along one side of the uterus, and the fetus lie more to the other side, then when the culbute is performed the funis must necessarily form a loop round the neck or chest of the infant. If it remain in this position, it is further stated, the mother will suffer later and the fetus will either perish or be born with difficulty. If the Hippocratic writers knew that this coiling is sometimes quite innocuous, they did not in any place state the fact.
The accompanying illustrations (Fig. 11) show the different ways in which the funis may be coiled, the coils sometimes being as many as 8.
Bizzen [2.191] mentions an instance in which from strangulation the head of a fetus was in a state of putrefaction, the funis being twice tightly bound around the neck. Cleveland, [2.192] Cuthbert, [2.193] and Germain [2.194] report analogous instances. Matthyssens [2.195] observed the twisting of the funis about the arm and neck of a fetus the body of which was markedly wasted. There was complete absence of amniotic fluid during labor. Blumenthal [2.196] presented to the New York Pathological Society an ovum within which the fetus was undergoing
subject are Avery, Boncour, Brown, Ware, Wrangell, Young, Nettekoven, Martin, Macan, Leopold, Hecker, Günther, and Friedinger.
Wygodzky [2.201] finds that the greatest number of coils of the umbilical cord ever found to encircle a fetus are 7 (Baudelocque), 8 (Credé), and 9 (Müller and Gray). His own case was observed this year in Wilna. The patient was a primipara aged twenty. The last period was seen on May 10, 1894. On February 19th the fetal movements suddenly ceased. On the 20th pains set in about two weeks before term. At noon turbid
Intrauterine fractures are occasionally seen, but are generally the results of traumatism or of some extraordinary muscular efforts on the part of the mother. A blow on the abdomen or a fall may cause them. The most interesting cases are those in which the fractures are multiple and the causes unknown. Spontaneous fetal fractures have been discussed thoroughly, and the reader is referred to any responsible text-book for the theories of causation. Atkinson, [2.202] De Luna, [2.203] and Keller report intrauterine fractures of the clavicle. Filippi [2.204] contributes an extensive paper on the medicolegal aspect of a case of intrauterine fracture of the os cranium. Braun of Vienna reports a case of intrauterine fracture of the humerus and femur. Rodrigue [2.205] describes a case of fracture and dislocation of the humerus of a fetus in utero. Gaultier [2.206] reports an instance of fracture of both femora intrauterine. Stanley, Vanderveer, and Young cite instances of intrauterine fracture of the thigh; in the case of Stanley the fracture occurred during the last week of gestation, and there was rapid union of the fragments during lactation. Danyau, Proudfoot, and Smith [2.207] mention intrauterine fracture of the tibia; in Proudfoot's case there was congenital talipes talus.
Dolbeau [2.208] describes an instance in which multiple fractureswere found in a fetus, some of which were evidently postpartum, while others were assuredly antepartum. Hirschfeld [2.209] describes a fetus showing congenital multiple fractures. Gross *[387] speaks of a wonderful case of Chaupier in which no less than 113 fractures were discovered in a child at birth. It survived twenty-four hours, and at the postmortem examination it was found that some were already solid, some uniting, whilst others were recent. It often happens that the intrauterine fracture is well united at birth. There seems to be a peculiar predisposition of the bones to fracture in the cases in which the fractures are multiple and the cause is not apparent.
The results to the fetus of injuries to the pregnant mother are most diversified. In some instances the marvelous escape of any serious consequences of one or both is almost incredible, while in others the slightest injury is fatal. Guillemont [2.210] cites the instance of a woman who was killed by a stroke of lightning, but whose fetus was saved; while Fabricius Hildanus [2.211] describes a case in which there was perforation of the head, fracture of the skull, and a wound of the groin, due to sudden starting and agony of terror of the mother. Here there was not the slightest history of any external violence.
It is a well-known fact that injuries to the pregnant mother show visible effects on the person of the fetus. The older writers kept a careful record of the anomalous and extraordinary injuries of this character and of their effects. Brendelius tells us of hemorrhage from the mouth and nose of the fetus occasioned by the fall of the mother; Buchner [2.212] mentions a case of fracture of the cranium from fright of the mother; Reuther describes a contusion of the os sacrum and abdomen in the mother from a fall, with fracture of the arm and leg of the fetus from the same cause; Sachse [2.213] speaks of a fractured tibia in a fetus, caused by a fall of the mother; Slevogt [2.214] relates an instance of rupture of the abdomen of a fetus by a fall of the mother; the Ephemerides contains accounts of injuries to the fetus of this nature, and among others mentions a stake as having been thrust into a fetus in utero; Verduc [2.215] offers several examples, one a dislocation of the fetal foot from a maternal fall; Plocquet *[356] gives an instance of fractured femur; Walther [2.216] describes a case of dislocation of the vertebræ from a fall; and there is also a case [2.217] of a fractured fetal vertebra from a maternal fall. There is recorded [2.218] a fetal scalp injury, together with clotted blood in the hair, after a fall of the mother: Autenrieth describes a wound of the pregnant uterus, which had no fatal issue, and there is also another similar case on record. [2.219]
The modern records are much more interesting and wonderful on this subject than the older ones. Richardson *[650] speaks of a woman falling down a few weeks before her delivery. Her pelvis was roomy and the birth was easy; but the infant was found to have extensive wounds on the back, reaching from the 3d dorsal vertebra across the scapula, along the back of the humerus, to within a short distance of the elbow. Part of these wounds were cicatrized and part still granulating, which shows that the process of reparation is as active in utero as elsewhere.
Injuries about the genitalia would naturally be expected to exercise some active influence on the uterine contents; but there are many instances reported in which the escape of injury is marvelous. Gibb [2.220] speaks of a woman, about eight months pregnant, who fell across a chair, lacerating her
There are some marvelous cases of recovery and noninterference with pregnancy after injuries from horns of cattle. Corey [2.225] speaks of a woman of thirty-five, three months pregnant, weighing 135 pounds, who was horned by a cow through the abdominal parietes near the hypogastric region; she was lifted into the air, carried, and tossed on the ground by the infuriated animal. There was a wound consisting of a ragged rent from above the os pubis, extending obliquely to the left and upward, through which protruded the great omentum, the descending and transverse colon, most of the small intestines, as well as the pyloric extremity of the stomach. The great omentum was mangled and comminuted, and bore two lacerations of two inches each. The intestines and stomach were not injured, but there was considerable extravasation of blood into the abdominal cavity. The intestines were cleansed and an unsuccessful attempt was made to replace them. The intestines remained outside of the body for two hours, and the great omentum was carefully spread out over the chest to prevent interference with the efforts to return the intestines. The patient remained conscious and calm throughout; finally deep anesthesia was produced by ether and chloroform, three and a half hours after the accident, and in twenty minutes the intestines were all replaced in the abdominal cavity. The edges were pared, sutured, and the wound dressed. The woman was placed in bed, on the
Luce [2.226] speaks of a pregnant woman who was horned in the lower part of the abdomen by a cow, and had a subsequent protrusion of the intestines through the wound. After some minor complications, the wound healed fourteen weeks after the accident, and the woman was confined in natural labor of a healthy, vigorous child. In this case no blood was found on the cow's horn, and the clothing was not torn, so that the wound must have been made by the side of the horn striking the greatly distended abdomen.
Richard, [2.227] quoted also by Tiffany, *[837] speaks of a woman, twenty-two, who fell in a dark cellar with some empty bottles in her hand, suffering a wound in the abdomen 2 inches above the navel on the left side 8 cm. long. Through this wound a mass of intestines, the size of a man's head, protruded. Both the mother and the child made a good convalescence. Harris [2.228] cites the instance of a woman of thirty, a multipara, six months pregnant, who was gored by a cow; her intestines and omentum protruded through the rip and the uterus was bruised. There was rapid recovery and delivery at term. Wetmore of Illinois saw a woman who in the summer of 1860, when about six months pregnant, was gored by a cow, and the large intestine and the omentum protruded through the wound. Three hours after the injury she was found swathed in rags wet with a compound solution of whiskey and camphor, with a decoction of tobacco. The intestines were cold to the touch and dirty, but were washed and replaced. The abdomen was sewed up with a darning needle and black linen thread; the woman recovered and bore a healthy child at the full maturity of her gestation. [2.229] Crowdace [2.230] speaks of a female pauper, six months pregnant, who was attacked by a buffalo, and suffered a wound about 1.2 inch long and 1/2 inch wide just above the umbilicus. Through this small opening 19 inches of intestine protruded. The woman recovered, and the fetal heart-beats could be readily auscultated.
Major accidents in pregnant women are often followed by the happiest results. There seems to be no limit to what the pregnant uterus can successfully endure. Tiffany, *[837] who has collected some statistics on this subject, as well as on operations successfully performed during pregnancy, which will be considered later, quotes [2.231] the account of a woman of twenty-seven, eight months pregnant, who was almost buried under a clay wall. She received terrible wounds about the head, 32 sutures being used in this location
Verrier [2.233] has collected the results of traumatism during pregnancy, and summarizes 61 cases. Prowzowsky [2.234] cites the instance of a patient in the eighth month of her first pregnancy who was wounded by many pieces of lead pipe fired from a gun but a few feet distant. Neither the patient nor the child suffered materially from the accident, and gestation proceeded; the child died on the fourth day after birth without apparent cause. Milner [2.235] records an instance of remarkable tolerance of injury in a pregnant woman. During her six months of pregnancy the patient was accidentally shot through the abdominal cavity and lower part of the thorax. The missile penetrated the central tendon of the diaphragm and lodged in the lung. The injury was limited by localized pneumonia and peritonitis, and the wound was drained through the lung by free expectoration. Recovery ensued, the patient giving birth to a healthy child sixteen weeks later. Belin [2.236] mentions a stab-wound in a pregnant woman from which a considerable portion of the epiploon protruded. Sloughing ensued, but the patient made a good recovery, gestation not being interrupted. Fancon [2.237] describes the case of a woman who had an injury to the knee requiring drainage. She was attacked by erysipelas, which spread over the whole body with the exception of the head and neck; yet her pregnancy was uninterrupted and recovery ensued. Fancon also speaks of a girl of nineteen, frightened by her lover, who threatened to stab her, who jumped from a second-story window. For three days after the fall she had a slight bloody flow from the vulva. Although she was six months pregnant there was no interruption of the normal course of gestation.
Bancroft [2.238] speaks of a woman who, being mistaken for a burglar, was shot by her husband with a 44-caliber bullet. The missile entered the second and third ribs an inch from the sternum, passed through the right lung, and escaped at the inferior angle of the scapula, about three inches below the spine; after leaving her body it went through a pine door. She suffered much hemorrhage and shock, but made a fair recovery at the end of four weeks, though pregnant with her first child at the seventh month. At full
All the cases do not have as happy an issue as most of the foregoing ones, though in some the results are not so bad as might be expected. A German female, thirty-six, while in the sixth month of pregnancy, fell and struck her abdomen on a tub. She was delivered of a normal living child, with the exception that the helix of the left ear was pushed anteriorly, and had, in its middle, a deep incision, which also traversed the antihelix and the tragus, and continued over the cheek toward the nose, where it terminated. The external auditory meatus was obliterated. Gurlt speaks of a woman, seven months pregnant, who fell from the top of a ladder, subsequently losing some blood and water from the vagina. She had also persistent pains in the belly, but there was no deterioration of general health. At her confinement, which was normal, a strong boy was born, wanting the arm below the middle, at which point a white bone protruded. The wound healed and the separated arm came away after birth. Wainwright [2.239] relates the instance of a woman of forty, who when six months pregnant was run over by railway cars. After a double amputation of the legs she miscarried and made a good recovery. Neugebauer [2.240] reported the history of a case of a woman who, while near her term of pregnancy, committed suicide by jumping from a window. She ruptured her uterus, and a dead child with a fracture of the parietal bone was found in the abdominal cavity. Staples [2.241] speaks of a Swede of twenty-eight, of Minnesota, who was accidentally shot by a young man riding by her side in a wagon. The ball entered the abdomen two inches above the crest of the right ilium, a little to the rear of the anterior superior spinous process, and took a downward and forward course. A little shock was felt but no serious symptoms followed. In forty hours there was delivery of a dead child with a bullet in its abdomen. Labor was normal and the internal recovery complete. Von Chelius, *[265] quoting the younger Naegele, gives a remarkable instance of a young peasant of thirty-five, the mother of four children, pregnant with the fifth child, who was struck on the belly violently by a blow from a wagon pole. She was thrown down, and felt a tearing pain which caused her to faint. It was found that the womb had been ruptured and the child killed, for in several days it was delivered in a putrid mass, partly through the natural passage and partly through an abscess opening in the abdominal wall. The woman made a good recovery. A curious accident of pregnancy [2.242] is that of a woman of thirty-eight, advanced eight months in her ninth pregnancy, who after eating a hearty meal was seized by a violent pain in the region of the stomach and soon afterward with convulsions, supposed to have been puerperal. She died in a few hours, and at the autopsy it was found that labor
Buzzard [2.244] had a case of nervous tremor in a woman, following a fall at her fourth month of pregnancy, who at term gave birth to a male child that was idiotic. Beatty [2.245] relates a curious accident to a fetus in utero. The woman was in her first confinement and was delivered of a small but healthy and strong boy. There was a small puncture in the abdominal parietes, through which the whole of the intestines protruded and were constricted. The opening was so small that he had to enlarge it with a bistoury to replace the bowel, which was dark and congested; he sutured the wound with silver wire, but the child subsequently died.
Tiffany *[837] of Baltimore has collected excellent statistics of operations during pregnancy; and Mann of Buffalo [2.246] has done the same work, limiting himself to operations on the pelvic organs, where interference is supposed to have been particularly contraindicated in pregnancy. Mann, after giving his individual cases, makes the following summary and conclusions:—
(1) Pregnancy is not a general bar to operations, as has been supposed.
(2) Union of the denuded surfaces is the rule, and the cicatricial tissue, formed during the earlier months of pregnancy, is strong enough to resist the shock of labor at term.
(3) Operations on the vulva are of little danger to mother or child.
(4) Operations on the vagina are liable to cause severe hemorrhage, but otherwise are not dangerous.
(5) Venereal vegetations or warts are best treated by removal.
(6) Applications of silver nitrate or astringents may be safely made to the vagina. For such application, phenol or iodin should not be used, pure or in strong solution.
(7) Operations on the bladder or urethra are not dangerous or liable to be followed by abortion.
(8) Operations for vesicovaginal fistulæ should not be done, as they are dangerous, and are liable to be followed by much hemorrhage and abortion.
(9) Plastic operations may be done in the earlier months of pregnancy with fair prospects of a safe and successful issue.
(10) Small polypi may be treated by torsion or astringents. If cut, there is likely to be a subsequent abortion.
(11) Large polypi removed toward the close of pregnancy will cause hemorrhage.
(12) Carcinoma of the cervix should be removed at once.
A few of the examples on record of operations during pregnancy of
Jacobson [2.254] cites a case of vaginal lithotomy in a patient six and a half months pregnant, with normal delivery at full term. Tiffany quotes Keelan's [2.255] description of a woman of thirty-five, in the eighth month of pregnancy, from whom he removed a stone weighing 12 1/2 ounces and measuring 2 by 2 1/2 inches, with subsequent recovery and continuation of pregnancy. Rydygier [2.256] mentions a case of obstruction of the intestine during the sixth month of gestation, showing symptoms of strangulation for seven days, in which he performed abdominal section. Recovery of the woman without abortion ensued. The Revue de Chirurgien 1887, contains an account of a woman who suffered internal strangulation, on whom celiotomy was performed; she recovered in twenty-five days, and did not miscarry, which shows that severe injury to the intestine with operative interference does not necessarily interrupt pregnancy. Gilmore, [2.257] without inducing abortion, extirpated the kidney of a negress, aged
Lovort [2.259] describes an enucleation of the eye in the second month of pregnancy. Pilcher [2.260] cites the instance of a woman of fifty-eight, eight months in her fourth pregnancy, whose breast and axilla he removed without interruption of pregnancy. Robson, [2.261] Polaillon, and Coen report similar instances.
Rein speaks of the removal of an enormous echinococcus cyst of the omentum without interruption of pregnancy. Robson [2.262] reports a multilocular cyst of the ovary with extensive adhesions of the uterus, removed at the tenth week of pregnancy and ovariotomy performed without any interruption of the ordinary course of labor. Russell [2.263] cites the instance of a woman who was successfully tapped at the sixth month of pregnancy.
McLean [2.264] speaks of a successful amputation during pregnancy; Napper, *[778] one of the arm; Nicod, one of the arm; Russell, [2.265] an amputation through the shoulder joint for an injury during pregnancy, with delivery and recovery; and Vesey [2.266] speaks of amputation for compound fracture of the arm, labor following ten hours afterward with recovery. Keen [2.267] reports the successful performance of a hip-joint amputation for malignant disease of the femur during pregnancy. The patient, who was five months advanced in gestation, recovered without aborting.
Robson reports a case of strangulated hernia in the third month of pregnancy with stercoraceous vomiting. He performed herniotomy in the femoral region, and there was a safe delivery at full term. In the second month of pregnancy he also rotated an ovarian tumor causing acute symptoms and afterward performed ovariotomy without interfering with pregnancy. Mann quotes Mundé in speaking of an instance of removal of elephantiasis of the vulva without interrupting pregnancy, and says that there are many cases of the removal of venereal warts without any interference with gestation. Campbell of Georgia operated inadvertently at the second and third month in two cases of vesicovaginal fistula in pregnant women. The first case showed no interruption of pregnancy, but in the second case the woman nearly died and the fistula remained unhealed. Engelmann operated on a large rectovaginal fistula in the sixth month of pregnancy without any interruption of pregnancy, which is far from the general result. Cazin and Rey both produced abortion by forcible dilatation of the anus for fissure, but Gayet used both the fingers and a speculum in a case at five months and the woman went to term. By cystotomy Reamy removed a double hair-pin
The following extract from the University Medical Magazine of Philadelphia illustrates the after-effects of abdominal hysteropasy on subsequent pregnancies:—
"Fraipont (Annales de la Société Médico-Chirurgicale de Liège, 1894) reports four cases where pregnancy and labor were practically normal, though the uterus of each patient had been fixed to the abdominal walls. In two of the cases the hysteropexy had been performed over five years before the pregnancy occurred, and, although the bands of adhesion between the fundus and the parietes must have become very tough after so long a period, no special difficulty was encountered. In two of the cases the forceps was used, but not on account of uterine inertia; the fetal head was voluminous, and in one of the two cases internal rotation was delayed. The placenta was always expelled easily, and no serious postpartum hemorrhage occurred. Fraipont observed the progress of pregnancy in several of these cases. The uterus does not increase specially in its posterior part, but quite uniformly, so that, as might be expected, the fundus gradually detaches itself from the abdominal wall. Even if the adhesions were not broken down they would of necessity be so stretched as to be useless for their original purpose after delivery. Bands of adhesion could not share in the process of involution. As, however, the uterus undergoes perfect involution, it is restored to its original condition before the onset of the disease which rendered hysteropexy necessary.''
The coexistence of an extensive tumor of the uterus with pregnancy does not necessarily mean that the product of conception will be blighted. Brochin [2.269] speaks of a case in which pregnancy was complicated with fibroma of the uterus, the accouchement being natural at term. Byrne [2.270] mentions a case of pregnancy complicated with a large uterine fibroid. Delivery was effected at full term, and although there was considerable hemorrhage the mother recovered. Ingleby [2.271] describes a case of fibrous tumor of the uterus terminating fatally, but not until three weeks after delivery. Lusk [2.272] mentions a case of pregnancy with fibrocystic tumor of the uterus occluding the cervix. At the appearance of symptoms of eclampsia version was performed and delivery effected, followed by postpartum hemorrhage. The mother died from peritonitis and collapse, but the stillborn child was resuscitated. Roberts [2.273] reports a case of pregnancy associated with a large fibrocellular polypus
Von Quast [2.274] speaks of a fibromyoma removed five days after labor. Gervis [2.275] reports the removal of a large polypus of the uterus on the fifth day after confinement. Davis [2.276] describes the spontaneous expulsion of a large polypus two days after the delivery of a fine, healthy, male child. Deason [2.277] mentions a case of anomalous tumor of the uterus during pregnancy which was expelled after the birth of the child; and Daly also [2.278] speaks of a tumor expelled from the uterus after delivery. Cathell [2.279] speaks of a case of pregnancy complicated with both uterine fibroids and measles. Other
cases of a similar nature to the foregoing are too numerous to mention. Figure 13, taken from Spiegelberg, shows a large fibroid blocking the pelvis of a pregnant woman.
There are several peculiar accidents and anomalies not previously mentioned which deserve a place here, viz., those of the membranes surrounding the fetus. Brown [2.280] speaks of protrusion of the membranes from the vulva several weeks before confinement. Davies [2.281] relates an instance in which there was a copious watery discharge during pregnancy not followed
Bardt [2.284] speaks of labor twenty-three days after the flow of the waters; and Cobleigh [2.285] one of seventeen days; Bradley [2.286] relates the history of a case of rupture of the membranes six weeks before delivery. Rains [2.287] cites an instance in which gestation continued three months after rupture of the membranes, the labor-pains lasting thirty-six hours. Griffiths *[523] speaks of rupture of the amniotic sac at about the sixth month of pregnancy with no untoward interruption of the completion of gestation and with delivery of a living child. There is another observation [2.288] of an accouchement terminating successfully twenty-three days after the loss of the amniotic fluid. Campbell [2.289] mentions delivery of a living child twelve days after rupture of the membranes. Chesney [2.290] relates the history of a double collection of waters. Wood [2.291] reports a case in which there was expulsion of a bag of waters before the rupture of the membranes. Bailly, Chestnut, Bjering, Cowger, Duncan, and others also record premature rupture of the membranes without interruption of pregnancy.
Harris [2.292] gives an instance of the membranes being expelled from the uterus a few days before delivery at the full term. Chatard, Jr., [2.293] mentions extrusion of the fetal membranes at the seventh month of pregnancy while the patient was taking a long afternoon walk, their subsequent retraction, and normal labor at term. Thurston [2.294] tells of a case in which Nature had apparently effected the separation of the placenta without alarming hemorrhage, the ease being one of placenta prævia, terminating favorably by natural processes.
Guerrant [2.296] gives a unique example of normal birth at full term in which the placenta was found in the vagina, but not a vestige of the membranes was noticed. The patient had experienced nothing unusual until within three months of expected confinement, since which time there had been a daily loss of water from the uterus. She recovered and was doing her work. There was no possibility that this was a case of retained secundines.
Anomalies of the Umbilical Cord.—Absence of the membranes has its counterpart in the deficiency of the umbilical cord, so frequently noticed in old reports. The Ephemerides, Osiander, Stark's Archives, *[160] Thiebault, van der Wiel, Chatton, and Schurig *[726] all speak of it, and it has been noticed since. Danthez [2.297] speaks of the development of a fetus in spite of the absence of an umbilical cord. Stute [2.298] reports an observation of total absence of the umbilical cord, with placental insertion near the cervix of the uterus.
There is mentioned [2.299] a bifid funis. The Ephemerides [2.300] and van der Wiel speak of a duplex funis. Nolde [2.301] reports a cord 38 inches long; and Werner [2.302] cites the instance of a funis 51 inches long. There are modern instances in which the funis has been bifid or duplex, and there is also a case reported in which there were two cords in a twin pregnancy, each of them measuring five feet in length. The Lancet [2.303] gives the account of a most peculiar pregnancy consisting of a placenta alone, the fetus wanting. What this "placenta'' was will always be a matter of conjecture.
Occasionally death of the fetus is caused by the formation of knots in the cord, shutting off the fetal circulation; Géry, Grieve, Mastin, Passot, Piogey, Woets, and others report instances of this nature. Newman [2.304] reports a curious case of twins, in which the cord of one child was encircled by a knot on the cord of the other. Among others, Latimer [2.305] and Motte [2.306] report instances of the accidental tying of the bowel with the funis, causing an artificial anus.
The diverse causes of abortion are too numerous to attempt giving them all, but some are so curious and anomalous that they deserve mention. Epidemics of abortion are spoken of by Fickius, Fischer, and the Ephemerides. Exposure to cold is spoken of as a cause, [2.307] and the same is alluded to by the Ephemerides; [2.308] while another case is given as due to exposure white nude. [2.309] There are several cases among the older writers in which odors are said to have produced abortion, but as analogues are not to be found in modern literature, unless the odor is very poisonous or pungent, we can give them but little credence. The Ephemerides gives the
The causes that are observed every day, such tight lacing, excessive venery, fright, and emotions, are too well known to be discussed here.
There has been reported a recent case of abortion following a viper-bite, and analogues may be found in the writings of Severinus and Oedman, who mention viper-bites as the cause; but there are so many associate conditions accompanying a snake-bite, such as fright, treatment, etc., any one of which could be a cause in itself, that this is by no means a reliable explanation. Information from India an this subject would be quite valuable.
The Ephemerides speak of bloodless abortion, and there have been modern instances in which the hemorrhage has been hardly noticeable.
Abortion in a twin pregnancy does not necessarily mean the abortion or death of both the products of conception. Chapman [2.317] speaks of the case of the expulsion of a blighted fetus at the seventh month, the living child remaining to the full term, and being safely delivered, the placenta following. Crisp [2.318] says of a case of labor that the head of the child was obstructed by a round body, the nature of which he was for some time unable to determine. He managed to push the obstructing body up and delivered a living, full-term child; this was soon followed by a blighted fetus, which was 11 inches long, weighed 12 ounces, with a placenta attached weighing 6 1/2 ounces. It is quite common for a blighted fetus to be retained and expelled at term with a living child, its twin.
Bacon [2.319] speaks of twin pregnancy, with the death of one fetus at the fourth month and the other delivered at term. Beall [2.320] reports the conception of twins,
There was a case at Riga in 1839 of a robust girl who conceived in February, and in consequence her menses ceased. In June she aborted, but, to her dismay, soon afterward the symptoms of advanced pregnancy appeared, and in November a full-grown child, doubtless the result of the same impregnation as the fetus, was expelled at the fourth month. In 1860 Schuh reported an instance before the Vienna Faculty of Medicine in which a fetus was discharged at the third month of pregnancy and the other twin retained until full term. The abortion was attended with much metrorrhagia, and ten weeks afterward the movements of the other child could be plainly felt and pregnancy continued its course uninterrupted. Bates [2.327] mentions a twin pregnancy in which an abortion took place at the second month and was followed by a natural birth at full term. Hawkins [2.328] gives a case of miscarriage, followed by a natural birth at full term; and Newnham [2.329] cites a similar instance in which there was a miscarriage at the seventh month and a birth at full term.
Worms in the Uterus.—Haines [2.330] speaks of a most curious case—that of a woman who had had a miscarriage three days previous; she suffered intense pain and a fetid discharge. A number of maggots were seen in the vagina, and the next day a mass about the size of an orange came away from the uterus, riddled with holes, and which contained a number of dead maggots, killed by the carbolic acid injection given soon after the miscarriage. The fact seems inexplicable, but after their expulsion the symptoms immediately ameliorated. This case recalls a somewhat similar one given by the older writers, in which a fetus was eaten by a worm. [2.331] Analogous are those cases spoken of by Bidel [2.332] of lumbricoides found in the uterus; by Hole, [2.333] in which maggots were found in the vagina and uterus; and Simpson, [2.334] in which the
We can find fabulous parallels to all of these in some of the older writings. Paré [2.335] mentions Lycosthenes' account of a woman in Cracovia in 1494 who bore a dead child which had attached to its back a live serpent, which had gnawed it to death. He gives an illustration (Fig. 14) showing the serpent in situ. He also quotes the case of a woman who conceived by a mariner, and who, after nine months, was delivered by a midwife of a shapeless mass, followed by an animal with a long neck, blazing eyes, and clawed feet. Ballantyne [2.336] says that in the writings of Hippocrates there is in the work on "Diseases'' (Περι νουσων), which is not usually regarded as genuine, a somewhat
curious statement with regard to worms in the fetus. It is affirmed that flat worms develop in the unborn infant, and the reason given is that the feces are expelled so soon after birth that there would not be sufficient time during extrauterine life for the formation of creatures of such a size. The same remark applies to round worms. The proof of these statements is to be found in the fact that many infants expel both these varieties of parasites with the first stool. It is difficult to know what to make of these opinions; for, with the exception of certain cases in some of the seventeenth and eighteenth century writers, there are no records in medicine of the occurrence of vermes in the infant at birth. It is possible that other things, such as dried pieces of mucus, may have been erroneously regarded as worms.
| CHAPTER II.
PRENATAL ANOMALIES. Anomalies and Curiosities of Medicine | |