anomalies and curiosities of medicine-第12部分

按键盘上方向键 ← 或 → 可快速上下翻页，按键盘上的 Enter 键可回到本书目录页，按键盘上方向键 ↑ 可回到本页顶部！
————未阅读完？加入书签已便下次继续阅读！


ty…five；　the　mother　of　nine　children；　most　of　whom　were　stillborn；　who　conceived　for　the　tenth　time；　the　gestation　being　normal　up　to　the　lying…in　period。　She　had　pains　followed　by　extraordinary　effusion　and　some　blood　into　the　vagina。　After　various　protracted　complaints　the　abdominal　tumor　became　painful　and　inflamed　in　the　umbilical　region。　A　breach　in　the　walls　soon　formed；　giving　exit　to　purulent　matter　and　all　the　bones　of　a　fetus。　During　this　process　the　patient　received　no　medical　treatment；　and　frequently　no　assistance　in　dressing　the　opening。　She　recovered；　but　had　an　artificial　anus　all　her　life。　Sarah　McKinna　was　married　at　sixteen　and　menstruated　for　the　first　time　a　month　thereafter。　Ten　months　after　marriage　she　showed　signs　of　pregnancy　and　was　delivered　at　full　term　of　a　living　child；　the　second　child　was　born　ten　months　after　the　first；　and　the　second　month　after　the　second　birth　she　again　showed　signs　of　pregnancy。　At　the　close　of　nine　months　these　symptoms；　with　the　exception　of　the　suppression　of　menses；　subsided；　and　in　this　state　she　continued　for　six　years。　During　the　first　four　years　she　felt　discomfort　in　the　region　of　the　umbilicus。　About　the　seventh　year　she　suffered　tumefaction　of　the　abdomen　and　thought　she　had　conceived　again。　The　abscess　burst　and　an　elbow　of　the　fetus　protruded　from　the　wound。　A　butcher　enlarged　the　wound　and；　fixing　his　finger　under　the　jaw　of　the　fetus；　extracted　the　head。　On　looking　into　the　abdomen　he　perceived　a　black　object；　whereupon　he　introduced　his　hand　and　extracted　piecemeal　an　entire　fetal　skeleton　and　some　decomposed　animal…matter。　The　abdomen　was　bound　up；　and　in　six　weeks　the　woman　was　enabled　to　superintend　her　domestic　affairs；　excepting　a　ventral　hernia　she　had　no　bad　after…results。　Kimura；　quoted　by　Whitney；　speaks　of　a　case　of　extrauterine　pregnancy　in　a　Japanese　woman　of　forty…one　similar　to　the　foregoing；　in　which　an　arm　protruded　through　the　abdominal　wall　above　the　umbilicus　and　the　remains　of　a　fetus　were　removed　through　the　aperture。　The　accompanying　illustration　shows　the　appearance　of　the　arm　in　situ　before　extraction　of　the　fetus　and　the　location　of　the　wound。

Bodinier　and　Lusk　report　instances　of　the　delivery　of　an　extrauterine　fetus　by　the　vagina；　and　Mathieson　relates　the　history　of　the　delivery　of　a　living　ectopic　child　by　the　vagina；　with　recovery　of　the　mother。　Gordon　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　conception　was　intrauterine　and　the　other　of　extrauterine　gestation；　have　been　recorded。　Clark　and　Ramsbotham　report　instances　of　double　conception；　one　fetus　being　born　alive　in　the　ordinary　manner　and　the　other　located　extrauterine。　Chasser　speaks　of　a　case　in　which　there　was　concurrent　pregnancy　in　both　the　uterus　and　the　Fallopian　tube。　Smith　cites　an　instance　of　a　woman　of　twenty…three　who　became　pregnant　in　August；　1870。　In　the　following　December　she　passed　fetal　bones　from　the　rectum；　and　a　month　later　gave　birth　to　an　intrauterine　fetus　of　six　months'　growth。　McGee　mentions　the　case　of　a　woman　of　twenty…eight　who　became　pregnant　in　July；　1872；　and　on　October　20th　and　21st　passed　several　fetal　bones　by　the　rectum；　and　about　four　months　later　expelled　some　from　the　uterus。　From　this　time　she　rapidly　recovered　her　strength　and　health。　Devergie　quotes　an　instance　of　a　woman　of　thirty　who　had　several　children；　but　who　died　suddenly；　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　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　in　the　tumor。　Hodgen　believed　this　to　have　been　originally　a　tubal　pregnancy；　which　burst；　causing　much　hemorrhage　and　the　death　of　the　fetus；　together　with　a　limited　peritonitis。　Beach　has　seen　a　twin　compound　pregnancy　in　which　after　connection　there　was　a　miscarriage　in　six　weeks；　and　four　years　after　delivery　of　an　extrauterine　fetus　through　the　abdominal　walls。　Cooke　cites　an　example　of　intrauterine　and　extrauterine　pregnancy　progressing　simultaneously　to　full　period　of　gestation；　with　resultant　death。　Rosset　reports　the　case　of　a　woman　of　twenty…seven；　who　menstruated　last　in　November；　1878；　and　on　August　5；　1879；　was　delivered　of　a　well…developed　dead　female　child　weighing　seven　pounds。　The　uterine　contractions　were　feeble；　and　the　attached　placenta　was　removed　only　with　difficulty；　there　was　considerable　hemorrhage。　The　hemorrhage　continued　to　occur　at　intervals　of　two　weeks；　and　an　extrauterine　tumor　remained。　Two　weeks　later　septicemia　supervened　and　life　was　despaired　of。　On　the　15th　of　October　a　portion　of　a　fetus　of　five　months'　growth　in　an　advanced　stage　of　decomposition　protruded　from　the　vulva。　After　the　escape　of　this　putrid　mass　her　health　returned；　and　in　four　months　she　was　again　robust　and　healthy。　Whinery　speaks　of　a　young　woman　who　at　the　time　of　her　second　child…birth　observed　a　tumor　in　the　abdomen　on　her　right　side　and　felt　motion　in　it。　In　about　a　month　she　was　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；　soon　ceasing　altogether；　and　the　wound　closed。　By　December　health　was　good　and　the　menses　had　returned。

Ahlfeld；　Ambrosioni；Galabin；　Packard；　Thiernesse；　Maxson；　de　Belamizaran；　Dibot；　and　Chabert　are　among　others　recording　the　phenomenon　of　coexisting　extrauterine　and　intrauterine　pregnancy。　Argles　mentions　simultaneous　extrauterine　fetation　and　superfetation。

Sanger　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　speaks　of　an　abdominal　fetus　being　taken　out　alive；　and　there　is　a　similar　case　on　record　in　the　early　part　of　this　century。　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　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　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　intrauterine　fetus　delivered　which　lived。　Of　11　such　cases　at　nine　months；　6　mothers　lived　and　6　intrauterine　fetuses　lived。　In　6　of　these　cases　no　operation　was　performed。　In　one　case　the　mother　died；　but　both　the　uterine　and　the　extrauterine　con