anomalies and curiosities of medicine-第22部分

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requency　and　serious　character　of　saturnine　encephalopathic　lesions。　The　presence　of　arsenic　in　the　fetal　skin　alone　gives　an　explanation　of　the　therapeutic　results　of　the　administration　of　this　substance　in　skin　diseases。

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；　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　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　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。　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　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　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　speaks　of　a　case　of　congenital　amputation　of　both　the　upper　extremities。　Gillilam　a　mentions　a　case　that　shows　the　deleterious　influence　of　even　the　weight　of　a　fetal　limb　resting　on　a　cord　or　band。　His　case　was　that　of　a　fetus；　the　product　of　a　miscarriage　of　traumatic　origin；　the　soft　tissues　were　almost　cut　through　and　the　bone　denuded　by　the　limb　resting　on　one　of　the　two　umbilical　cords；　not　encircling　it；　but　in　a　sling。　The　cord　was　deeply　imbedded　in　the　tissues。

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；　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　show　the　different　ways　in　which　the　funis　may　be　coiled；　the　coils　sometimes　being　as　many　as　8。

Bizzen　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；　Cuthbert；　and　Germain　report　analogous　instances。　Matthyssens　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　presented　to　the　New　York　Pathological　Society　an　ovum　within　which　the　fetus　was　under　going　intrauterine　decapitation。　Buchanan　describes　a　case　illustrative　of　the　etiology　of　spontaneous　amputation　of　limbs　in　utero　Nebinger　reports　a　case　of　abortion；　showing　commencing　amputation　of　the　left　thigh　from　being　encircled　by　the　funis。　The　death　of　the　fetus　was　probably　due　to　compression　of　the　cord。　Owen　mentions　an　instance　in　which　the　left　arm　and　hand　of　a　fetus　were　found　in　a　state　of　putrescence　from　strangulation；　the　funis　being　tightly　bound　around　at　the　upper　part。　Simpson　published　an　article　on　spontaneous　amputation　of　the　forearm　and　rudimentary　regeneration　of　the　hand　in　the　fetus。　Among　other　contributors　to　this　subject　are　Avery；　Boncour；　Brown；　Ware；　Wrangell；　Young；　Nettekoven；　Martin；　Macan；　Leopold；　Hecker；　Gunther；　and　Friedinger。

Wygodzky　finds　that　the　greatest　number　of　coils　of　the　umbilical　cord　ever　found　to　encircle　a　fetus　are　7　（Baudelocque）；　8　（Crede）；　and　9　（Muller　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　liquor　amnii　escaped。　At　2　P。M。；　on　examination；　Wygodzky　defined　a　dead　fetus　in　left　occipito…anterior　presentation；　very　high　in　the　inlet。　The　os　was　nearly　completely　dilated；　the　pains　strong。　By　4　P。M。　the　head　was　hardly　engaged　in　the　pelvic　cavity。　At　7　P。M。　it　neared　the　outlet　at　the　height　of　each　pain；　but　retracted　immediately　afterward。　After　10　P。M。　the　pains　grew　weak。　At　midnight　Wygodzky　delivered　the　dead　child　by　expression。　Not　till　then　was　the　cause　of　delay　clear。　The　funis　was　very　tense　and　coiled　7　times　round　the　neck　and　once　round　the　left　shoulder；　there　was　also　a　distinct　knot。　It　measured　over　65　inches　in　length。　The　fetus　was　a　male；　slightly　macerated。　It　weighed　over　5　pounds；　and　was　easily　delivered　entire　after　division　and　unwinding　of　the　funis。　No　marks　remained　on　the　neck。　The　placenta　followed　ten　minutes　later　and；　so　far　as　naked…eye　experience　indicated；　seemed　healthy。

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；　De　Luna；　and　Keller　report　intrauterine　fractures　of　the　clavicle。　Filippi　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　describes　a　case　of　fracture　and　dislocation　of　the　humerus　of　a　fetus　in　utero。　Gaultier　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　mention　intrauterine　fracture　of　the　tibia；　in　Proudfoot's　case　there　was　congenital　talipes　talus。

Dolbeau　describes　an　instance　in　which　multiple　fractures　were　found　in　a　fetus；　some　of　which　were　evidently　postpartum；　while　others　were　assuredly　antepartum。　Hirschfeld　describes　a　fetus　showing　congenital　multiple　fractures。　Gross　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　cites　the　instance　of　a　woman　who　was　killed　by　a　stroke　of　lightning；　but　whose　fetus　was　saved；　while　Fabricius　Hildanus　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　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　speaks　of　a　fractured　tibia　in　a　fetus；　caused　by　a　fall　of　the　mother；　Slevogt　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　offers　several　examples；　one　a　dislocation　of　the　fetal　fo