anomalies and curiosities of medicine-第24部分

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ntation　of　a　healthy　boy。　The　mother　at　the　time　of　report　was　healthy　and　free　from　cough；　and　was　nursing　her　babe；　which　was　strong　and　bright。

All　the　cases　do　not　have　as　happy　an　issue　as　most　of　the　foregoing　ones；　though　in　some　the　results　are　not　so　bad　as　might　be　expected。　A　German　female；　thirty…six；　while　in　the　sixth　month　of　pregnancy；　fell　and　struck　her　abdomen　on　a　tub。　She　was　delivered　of　a　normal　living　child；　with　the　exception　that　the　helix　of　the　left　ear　was　pushed　anteriorly；　and　had；　in　its　middle；　a　deep　incision；　which　also　traversed　the　antihelix　and　the　tragus；　and　continued　over　the　cheek　toward　the　nose；　where　it　terminated。　The　external　auditory　meatus　was　obliterated。　Gurlt　speaks　of　a　woman；　seven　months　pregnant；　who　fell　from　the　top　of　a　ladder；　subsequently　losing　some　blood　and　water　from　the　vagina。　She　had　also　persistent　pains　in　the　belly；　but　there　was　no　deterioration　of　general　health。　At　her　confinement；　which　was　normal；　a　strong　boy　was　born；　wanting　the　arm　below　the　middle；　at　which　point　a　white　bone　protruded。　The　wound　healed　and　the　separated　arm　came　away　after　birth。　Wainwright　relates　the　instance　of　a　woman　of　forty；　who　when　six　months　pregnant　was　run　over　by　railway　cars。　After　a　double　amputation　of　the　legs　she　miscarried　and　made　a　good　recovery。　Neugebauer　reported　the　history　of　a　case　of　a　woman　who；　while　near　her　term　of　pregnancy；　committed　suicide　by　jumping　from　a　window。　She　ruptured　her　uterus；　and　a　dead　child　with　a　fracture　of　the　parietal　bone　was　found　in　the　abdominal　cavity。　Staples　speaks　of　a　Swede　of　twenty…eight；　of　Minnesota；　who　was　accidentally　shot　by　a　young　man　riding　by　her　side　in　a　wagon。　The　ball　entered　the　abdomen　two　inches　above　the　crest　of　the　right　ilium；　a　little　to　the　rear　of　the　anterior　superior　spinous　process；　and　took　a　downward　and　forward　course。　A　little　shock　was　felt　but　no　serious　symptoms　followed。　In　forty　hours　there　was　delivery　of　a　dead　child　with　a　bullet　in　its　abdomen。　Labor　was　normal　and　the　internal　recovery　complete。　Von　Chelius；　quoting　the　younger　Naegele；　gives　a　remarkable　instance　of　a　young　peasant　of　thirty…five；　the　mother　of　four　children；　pregnant　with　the　fifth　child；　who　was　struck　on　the　belly　violently　by　a　blow　from　a　wagon　pole。　She　was　thrown　down；　and　felt　a　tearing　pain　which　caused　her　to　faint。　It　was　found　that　the　womb　had　been　ruptured　and　the　child　killed；　for　in　several　days　it　was　delivered　in　a　putrid　mass；　partly　through　the　natural　passage　and　partly　through　an　abscess　opening　in　the　abdominal　wall。　The　woman　made　a　good　recovery。　A　curious　accident　of　pregnancy　is　that　of　a　woman　of　thirty…eight；　advanced　eight　months　in　her　ninth　pregnancy；　who　after　eating　a　hearty　meal　was　seized　by　a　violent　pain　in　the　region　of　the　stomach　and　soon　afterward　with　convulsions；　supposed　to　have　been　puerperal。　She　died　in　a　few　hours；　and　at　the　autopsy　it　was　found　that　labor　had　not　begun；　but　that　the　pregnancy　had　caused　a　laceration　of　the　spleen；　from　which　had　escaped　four　or　five　pints　of　blood。　Edge　speaks　of　a　case　of　chorea　in　pregnancy　in　a　woman　of　twenty…seven；　not　interrupting　pregnancy　or　retarding　safe　delivery。　This　had　continued　for　four　pregnancies；　but　in　the　fourth　abortion　took　place。

Buzzard　had　a　case　of　nervous　tremor　in　a　woman；　following　a　fall　at　her　fourth　month　of　pregnancy；　who　at　term　gave　birth　to　a　male　child　that　was　idiotic。　Beatty　relates　a　curious　accident　to　a　fetus　in　utero。　The　woman　was　in　her　first　confinement　and　was　delivered　of　a　small　but　healthy　and　strong　boy。　There　was　a　small　puncture　in　the　abdominal　parietes；　through　which　the　whole　of　the　intestines　protruded　and　were　constricted。　The　opening　was　so　small　that　he　had　to　enlarge　it　with　a　bistoury　to　replace　the　bowel；　which　was　dark　and　congested；　he　sutured　the　wound　with　silver　wire；　but　the　child　subsequently　died。

Tiffany　of　Baltimore　has　collected　excellent　statistics　of　operations　during　pregnancy；　and　Mann　of　Buffalo　has　done　the　same　work；　limiting　himself　to　operations　on　the　pelvic　organs；　where　interference　is　supposed　to　have　been　particularly　contraindicated　in　pregnancy。　Mann；　after　giving　his　individual　cases；　makes　the　following　summary　and　conclusions：

（1）　Pregnancy　is　not　a　general　bar　to　operations；　as　has　been　supposed。

（2）　Union　of　the　denuded　surfaces　is　the　rule；　and　the　cicatricial　tissue；　formed　during　the　earlier　months　of　pregnancy；　is　strong　enough　to　resist　the　shock　of　labor　at　term。

（3）　Operations　on　the　vulva　are　of　little　danger　to　mother　or　child。

（4）　Operations　on　the　vagina　are　liable　to　cause　severe　hemorrhage；　but　otherwise　are　not　dangerous。

（5）　Venereal　vegetations　or　warts　are　best　treated　by　removal。

（6）　Applications　of　silver　nitrate　or　astringents　may　be　safely　made　to　the　vagina。　For　such　application；　phenol　or　iodin　should　not　be　used；　pure　or　in　strong　solution。

（7）　Operations　on　the　bladder　or　urethra　are　not　dangerous　or　liable　to　be　followed　by　abortion。

（8）　Operations　for　vesicovaginal　fistulae　should　not　be　done；　as　they　are　dangerous；　and　are　liable　to　be　followed　by　much　hemorrhage　and　abortion。

（9）　Plastic　operations　may　be　done　in　the　earlier　months　of　pregnancy　with　fair　prospects　of　a　safe　and　successful　issue。

（10）　Small　polypi　may　be　treated　by　torsion　or　astringents。　If　cut；　there　is　likely　to　be　a　subsequent　abortion。

（11）　Large　polypi　removed　toward　the　close　of　pregnancy　will　cause　hemorrhage。

（12）　Carcinoma　of　the　cervix　should　be　removed　at　once。

A　few　of　the　examples　on　record　of　operations　during　pregnancy　of　special　interest；　will　be　given　below。　Polaillon　speaks　of　a　double　ovariotomy　on　a　woman　pregnant　at　three　months；　with　the　subsequent　birth　of　a　living　child　at　term。　Gordon　reports　five　successful　ovariotomies　during　pregnancy；　in　Lebedeff's　clinic。　Of　these　cases；　1　aborted　on　the　fifth　day；　2　on　the　fifteenth；　and　the　other　2　continued　uninterrupted。　He　collected　204　cases　with　a　mortality　of　only　3　per　cent；　22　per　cent　aborted；　and　69。4　per　cent　were　delivered　at　full　term。　Kreutzman　reports　two　cases　in　which　ovarian　tumors　were　successfully　removed　from　pregnant　subjects　without　the　interruption　of　gestation。　One　of　these　women；　a　secundipara；　had　gone　two　weeks　over　time；　and　had　a　large　ovarian　cyst；　the　pedicle　of　which　had　become　twisted；　the　fluid　in　the　cyst　being　sanguineous。　May　describes　an　ovariotomy　performed　during　pregnancy　at　Tottenham　Hospital。　The　woman；　aged　twenty…two；　was　pale；　diminutive　in　size；　and　showed　an　enormous　abdomen；　which　measured　50　inches　in　circumference　at　the　umbilicus　and　27　inches　from　the　ensiform　cartilage　to　the　pubes。　At　the　operation；　36　pints　of　brown　fluid　were　drawn　off。　Delivery　took　place　twelve　hours　after　the　operation；　the　mother　recovering；　but　the　child　was　lost。　Galabin　had　a　case　of　ovariotomy　performed　on　a　woman　in　the　sixth　month　of　pregnancy　without　interruption　of　pregnancy；　Potter　had　a　case　of　double　ovariotomy　with　safe　delivery　at　term；　and　Storry　had　a　similar　case。　Jacobson　cites　a　case　of　vaginal　lithotomy　in　a　patient　six　and　a　half　months　pregnant；　with　normal　delivery　at　full　term。　Tiffany　quotes　Keelan's　description　of　a　woman　of　thirty…five；　in　the　eighth　month　of　pregnancy；　from　whom　he　removed　a　stone　weighing　12　1/2　ounces　and　measuring　2　by　2　1/2　inches；　with　subsequent　recovery　and　continuation　of　pregnancy。　Rydygier　mentions　a　case　of　obstruction　of　the　intestine　during　the　sixth　month　of　gestation；　showing　symptoms　of　strangulation　for　seven　days；　in　which　he　performed　abdominal　section。　Recovery　of　the　woman　without　abortion　ensued。　The　Revue　de　Chirurgien　1887；　contains　an　account　of　a　woman　who　suffered　internal　strangulation；　on　whom　celiotomy　was　performed；　she　recovered　in　twenty…five　days；　and　did　not　miscarry；　which　shows　that　severe　injury　to　the　intestine　with　operative　interference　does　not　necessarily　interrupt　pregnancy。　Gilmore；　without　inducing　abortion；　extirpated　the　kidney　of　a　negress；　aged　thirty…three；　for　severe　and　constant　pain。　Tiffany　removed　the　kidney　of　a　woman　of　twenty…seven；　five　months　pregnant；　without　interruption　of　this　or　subsequent　pregnancies。　The　child　was　living。　He　says　that　Fancon　cites　instances　of　operation　without　abortion。

Lovort　describes　an　enucleation　of　the　eye　in　the　second　month　of　pregnancy。　Pilcher　cites　the　instance　of　a　woman　of　fifty…eight；　eight　months　in　her　fourth　pregnancy；　whose　breast　and　axilla　he　removed　without　interruption　of　pregnancy。　Robson；　Polaillon；　and　Coen　report　similar　instances。

Rein　speaks　of　the　removal　of　an　enormous　echinococcus　cyst　of　the　omentum　without　interruption　of　pregnancy。　Robson　reports　a　multi…locular　cyst　of　the　ovary　with　extensive　adhesions　of　the　uterus；　removed　at　the　tenth　week　of　pregnancy　and　ovariotomy　performed　without　any　interruption　of　the　ordinary　course　of　labor。　Russell　cites　the　instance　of　a　woman　who　was　successfully　tapped　at　the　sixth　month　of　pregnancy。

McLean　speaks　of　a　successful　amputation　during　pregnancy；　Napper；　one　of　the　arm；　Nicod；　one　of　the　arm；　Russell；　an　amputation　through　the　shoulder　joint　for　an　injury　during　pregnancy；　with　delivery　and　recovery；　and　Vesey　speaks　of　amputation　for　compound　fracture　of　the　arm；　labor　following　ten　hours　afterward　with　recovery。　Keen　reports　the　successful　performance　of　a　hip…joint　amputation　for　malignant　disease　of　the　femur　during　pregnancy。　The　patient；　who　was　five　months　advanced　in　gestation；　recovered　without　aborting。

Robson　reports　a　case　of　strangulated　hernia　in　the　third　month　of　pregnancy　with　stercoraceous　vomiting。　He　performed　herniotomy　in　the　femoral　region；　and　there　was　a　safe　delivery　at　full　term。　In　the　second　month　of　pregnancy　he　also　rotated　an　ovarian　tumor　causing　acute　symptoms　and　afterward　performed　ovariotomy　without　interfering　with　pregnancy。　Mann　quotes　Munde　in　speaking　of　an　instance　of　removal　of　elephantiasis　of　the　vulva　without　interrupting　pregnancy；　and　says　that　there　are　many　cases　of　the　removal　of　venereal　warts　without　any　interference　with　gestation。　Campbell　of　Georgia　operated　inadvertently　at　the　second　and　third　month　in　two　cases　of　vesicovaginal　fist