anomalies and curiosities of medicine-第16部分

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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　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　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　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　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　has　seen　protraction　to　the　thirteenth　month。　Enguin　reports　an　observation　of　an　accouchement　of　twins　after　a　pregnancy　that　had　been　prolonged　for　eleven　months。　Resnikoff　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　reports　an　instance　of　partus　serotinus　in　which　the　product　of　conception　was　carried　in　the　uterus　forty　days　after　term。　The　fetus　was　macerated　but　not　putrid；　and　the　placenta　had　undergone　fatty　degeneration。　At　a　recent　meeting　of　the　Chicago　Gynecological　Society；　Dr。　F。　A。　Stahl　reported　the　case　of　a　German…Bohemian　woman　in　which　the　fifth　pregnancy　terminated　three　hundred　and　two　days　after　the　last　menstruation。　Twenty　days　before　there　had　occurred　pains　similar　to　those　of　labor；　but　they　gradually　ceased。　The　sacral　promontory　was　exaggerated；　and　the　anteroposterior　pelvic　diameter　of　the　inlet　in　consequence　diminished。　The　fetus　was　large　and　occupied　the　first　position。　Version　was　with　difficulty　effected　and　the　passage　of　the　after…coming　head　through　the　superior　strait　required　expression　and　traction；　during　which　the　child　died。　The　mother　suffered　a　deep　laceration　of　the　perineum　involving　an　inch　of　the　wall　of　the　rectum。

Among　others　reporting　instances　of　protracted　pregnancy　are　Collins；　eleven　months；　Desbrest；　eighteen　months；　Henderson；　fifteen　months；　Jefferies；　three　hundred　and　fifty…eight　days；　and　De　la　Vergne　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　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　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；　in　fact；　none　of　the　usual　signs　of　pregnancy　present。　He　gave　her　an　opiate；　and　to　her　surprise；　in　about　six　hours　she　was　the　mother　of　a　boy　weighing　five　pounds。　Both　the　mother　and　child　made　a　good　recovery。　Duke　cites　the　instance　of　a　woman　who　supposed　that　she　was　not　pregnant　up　to　the　night　of　her　miscarriage。　She　had　menstruated　and　was　suckling　a　child　sixteen　months　old。　During　the　night　she　was　attacked　with　pains　resembling　those　of　labor　and　a　fetus　slipped　into　the　vagina　without　any　hemorrhage；　the　placenta　came　away　directly　afterward。　In　this　peculiar　case　the　woman　was　menstruating　regularly；　suckling　a　child；　and　at　the　same　time　was　unconsciously　pregnant。

Isham　speaks　of　a　case　of　unconscious　pregnancy　in　which　extremely　small　twins　were　delivered　at　the　eighth　month。　Fox　cites　an　instance　of　a　woman　who　had　borne　eight　children；　and　yet　unconscious　of　pregnancy。　Merriman　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　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　record　peculiar　cases；　and　Mouronval　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　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　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　and　by　the　child　is　felt；　the　physician　takes　it　for　granted；　and　this　goes　on　until　the　great　diagnostician；　Time；　corrects　the　delusion。　Then　the　fat　disappears　with　remarkable　speed；　and　the　reign　of　this　singular　simulation　is　at　an　end。〃　In　the　same　article；　Dr。　Mitchell　cites　the　two　following　cases　under　his　personal　observation：　〃I　was　consulted　by　a　lady　in　regard　to　a　woman　of　thirty　years　of　age；　a　nurse　in　whom　she　was　interested。　This　person　had　been　married　some　three　years　to　a　very　old　man　possessed　of　a　considerable　estate。　He　died；　leaving　his　wife　her　legal　share　and　the　rest　to　distant　cousins；　unless　the　wife　had　a　child。　For　two　months　before　he　died　the　woman；　who　was　very　anemic；　ceased　to　menstruate。　She　became　sure　that　she　was　pregnant；　and　thereupon　took　on　flesh　at　a　rate　and　in　a　way　which　seemed　to　justify　her　belief。　Her　breasts　and　abdomen　were　the　chief　seats　of　this　overgrowth。　The　menses　did　not　return；　her　pallor　increased；　the　child　was　felt；　and　every　preparation　made　for　delivery。　At　the　eighth　month　a　physician　made　an　examination　and　assured　her　of　the　absence　of　pregnancy。　A　second　medical　opinion　confirmed　the　first；　and　the　tenth　month　found　her　of　immense　size　and　still　positive　as　to　her　condition。　At　the　twelfth　month　her　menstrual　flow　returned；　and　she　became　sure　it　was　the　early　sign　of　labor。　When　it　passed　over　she　became　convinced　of　her　error；　and　at　once　dropped　weight　at　the　rate　of　half　a　pound　a　day　despite　every　effort　to　limit　the　rate　of　this　remarkable　loss。　At　the　end　of　two　months　she　had　parted　with　fifty　pounds　and　was；　on　the　whole；　less　anemic。　At　this　stage　I　was　consulted　by　letter；　as　the　woman　had　become　exceedingly　hysteric。　This　briefly　stated　case；　which　occurred　many　years　ago；　is　a　fair　illustration　of　my　thesis。

〃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