anomalies and curiosities of medicine-第17部分

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　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；　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。　A　woman　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　mammae　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　speaks　of　a　female　who　had　been　pregnant　several　times；　but　again　experienced　the　signs　of　pregnancy。　Her　mammae　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　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　menses　stopped；　the　breasts　began　to　enlarge　and　became　discolored　around　the　nipples。　She　had　morning…sickness　of　a　violent　nature　and　her　abdomen　enlarged。　On　consultation　with　the　ladies　of　her　court；　her　opinion　of　pregnancy　was　strongly　confirmed。　Her　favorite　amusement　then　was　to　make　baby…clothes　and　count　on　her　fingers　the　months　of　pregnancy。　When　the　end　of　the　ninth　month　approached；　the　people　were　awakened　one　night　by　the　joyous　peals　of　the　bells　of　London　announcing　the　new　heir。　An　ambassador　had　been　sent　to　tell　the　Pope　that　Mary　could　feel　the　new　life　within　her；　and　the　people　rushed　to　St。　Paul's　Cathedral　to　listen　to　the　venerable　Archbishop　of　Canterbury　describe　the　baby…prince　and　give　thanks　for　his　deliverance。　The　spurious　labor　pains　passed　away；　and　after　being　assured　that　no　real　pregnancy　existed　in　her　case；　Mary　went　into　violent　hysterics；　and　Philip；　disgusted　with　the　whole　affair；　deserted　her；　then　commenced　the　persecution　of　the　Protestants；　which　blighted　the　reign。

Putnam　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　areolae　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　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；　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　attached　to　her　bed。　The　finger　on　the　abdomen　or　vulva　elicited　symptoms　of　great　sensitiveness。　He　told　her　she　was　not　pregnant；　and　the　next　day　she　was　sitting　up；　though　the　discharge　continued；　but　the　simulated　throes　of　labor；　which　she　had　so　graphically　pictured；　had　ceased。

Haultain　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　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　areolae　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　morning…sickness；　which　came　on　with　the　first　occurrence　of　this　sign　in　his　wife；　as　had　been　the　case　twice　before　in　her　former　pregnancies。　I　advised　him　to　leave　home；　and　this　proved　effectual。　I　learned　later　that　the　woman　continued　to　gain　flesh　and　be　sick　every　morning　until　the　seventh　month。　Then　menstruation　returned；　an　examination　was　made；　and　when　sure　that　there　was　no　possibility　of　her　being　pregnant　she　began　to　lose　flesh；　and　within　a　few　months　regained　her　usual　size。〃

Hamill　reports　an　instance　of　morning…sickness　in　a　husband　two　weeks　after　the　appearance　of　menstruation　in　the　wife　for　the　last　time。