anomalies and curiosities of medicine-第11部分

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ould　even　kill　an　unfaithful　wife。　Both　the　mother　and　the　mysterious　white　baby　are　doing　well。　Bouillon　speaks　of　a　negress　in　Guadeloupe　who　bore　twins；　one　a　negro　and　the　other　a　mulatto。　She　had　sexual　congress　with　both　a　negro　and　a　white　man。

Delmas；　a　surgeon　of　Rouen；　tells　of　a　woman　of　thirty…six　who　was　delivered　in　the　hospital　of　his　city　on　February　26；　1806；　of　two　children；　one　black　and　the　other　a　mulatto。　She　had　been　pregnant　eight　months；　and　had　had　intercourse　with　a　negro　twice　about　her　fourth　month　of　pregnancy；　though　living　with　the　white　man　who　first　impregnated　her。　Two　placentae　were　expelled　some　time　after　the　twins；　and　showed　a　membranous　junction。　The　children　died　shortly　after　birth。

Pregnancy　often　takes　place　in　a　unicorn　or　bicorn　uterus；　leading　to　similar　anomalous　conditions。　Galle；　Hoffman；　Massen；　and　Sanger　give　interesting　accounts　of　this　occurrence；　and　Ross　relates　an　instance　of　triple　pregnancy　in　a　double　uterus。　Cleveland　describes　a　discharge　of　an　anomalous　deciduous　membrane　during　pregnancy　which　was　probably　from　the　unimpregnated　half　of　a　double　uterus。



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；　during　the　eleventh　century；　extrauterine　pregnancy　is　discussed；　and　later　the　works　of　N。　Polinus　and　Cordseus；　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？〃　Many　of　the　older　writers　mention　this　form　of　fetation　as　a　curiosity；　but　offer　no　explanation　as　to　its　cause。　Mauriceau　and　de　Graaf　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；　and　again；　cases　supposed　to　be　only　extrauterine　have　been　instances　simply　of　double　uterus；　with　single　or　concurrent　pregnancy。　Ross　speaks　of　a　woman　of　thirty…three　who　had　been　married　fourteen　years；　had　borne　six　children；　and　who　on　July　16；　1870；　miscarried　with　twins　of　about　five　months'　development。　After　a　week　she　declared　that　she　was　still　pregnant　with　another　child；　but　as　the　physician　had　placed　his　hand　in　the　uterine　cavity　after　the　abortion；　he　knew　the　fetus　must　be　elsewhere　or　that　no　pregnancy　existed。　We　can　readily　see　how　this　condition　might　lead　to　a　diagnosis　of　extrauterine　pregnancy；　but　as　the　patient　insisted　on　a　thorough　examination；　the　doctor　found　by　the　stethoscope　the　presence　of　a　beating　fetal　heart；　and　by　vaginal　examination　a　double　uterus。　On　introducing　a　sound　into　the　new　aperture　he　discovered　that　it　opened　into　another　cavity；　but　as　the　woman　was　pregnant　in　this；　he　proceeded　no　further。　On　October　31st　she　was　delivered　of　a　female　child　of　full　growth。　She　had　menstruated　from　this　bipartite　uterus　three　times　during　the　period　between　the　miscarriage　of　the　twins　and　the　birth　of　the　child。　Both　the　mother　and　child　did　well。

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　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　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　speaks　in　full　of　such　cases；　Bartholinus；　Salmuth；　and　a　Reyes　speak　of　women　vomiting　remnants　of　fetuses。　In　Germany；　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　in　which　the　bones　of　a　fetus　were　discharged　at　stool；　causing　intense　pain。　Armstrong　describes　an　anomalous　case　of　pregnancy　in　a　syphilitic　patient　who　discharged　fetal　bones　by　the　rectum。　Bubendorf　reports　the　spontaneous　elimination　of　a　fetal　skeleton　by　the　rectum　after　five　years　of　retention；　with　recovery　of　the　patient。　Butcher　speaks　of　delivery　through　the　rectum　at　the　fourth　month；　with　recovery。　Depaul　mentions　a　similar　expulsion　after　a　pregnancy　of　about　two　months　and　a　half。　Jackson　reports　the　dissection　of　an　extrauterine　sac　which　communicated　freely　with　the　large　intestine。　Peck　has　an　example　of　spontaneous　delivery　of　an　extrauterine　fetus　by　the　rectum；　with　recovery　of　the　mother。　Skippon；　in　the　early　part　of　the　last　century；　reports　the　discharge　of　the　bones　of　a　fetus　through　an　〃imposthume〃　in　the　groin。　Other　cases　of　anal　discharge　of　the　product　of　extrauterine　conception　are　recorded　by　Winthrop；　Woodbury；　Tuttle；　Atkinson；　Browne；　Weinlechner；　Gibson；　Littre；　Magruder；　Gilland；　and　many　others。　De　Brun　du　Bois…Noir　speaks　of　the　expulsion　of　extrauterine　remains　by　the　anus　after　seven　years；　and　Heyerdahl　after　thirteen　years。　Benham　mentions　the　discharge　of　a　fetus　by　the　rectum；　there　was　a　stricture　of　the　rectum　associated　with　syphilitic　patches；　necessitating　the　performance　of　colotomy。

Bartholinus　and　Rosseus　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　reported　an　instance　of　the　discharge　of　fetal　remains　through　the　bladder。

Discharge　of　the　Fetus　through　the　Abdominal　Walls。Margaret　Parry　of　Berkshire　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　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　speaks　of　an　abdominal　pregnancy　in　which　there　was　spontaneous　perforation　of　the　anterior　abdominal　parietes；　followed　by　death。　Bouzal　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；　the　mother　of　nine　children；　most　of　whom　were　stillborn；　who　conceived　for　the　tenth　time；